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Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO) : A nationwide prospective intervention study

Osterlund, Pia (author)
Karolinska Institutet,Tampere Univ Hosp, Dept Oncol, Teiskontie 35,POB 2000, Tampere 33520, Finland.;Univ Tampere, Tampere, Finland.;Helsinki Univ Hosp, Dept Oncol, Helsinki, Finland.;Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden.
Salminen, Tapio (author)
Tampere Univ Hosp, Dept Oncol, Teiskontie 35,POB 2000, Tampere 33520, Finland.;Univ Tampere, Tampere, Finland.
Soveri, Leena-Maija (author)
Helsinki Univ Hosp, Dept Oncol, Helsinki, Finland.;Hyvinkaa Hosp & Home Care, Dept Palliat Care, Hyvinkaa, Finland.
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Kallio, Raija (author)
Oulu Univ Hosp, Dept Oncol, Oulu, Finland.;Univ Oulu, Oulu, Finland.
Kellokumpu, Ilmo (author)
Cent Hosp Cent Finland, Dept Gastrointestinal Surg, Jyyaskyla, Finland.
Lamminmäki, Annamarja (author)
Kuopio Univ Hosp, Dept Oncol, Kuopio, Finland.;Univ Kuopio, Kuopio, Finland.
Halonen, Päivi (author)
Helsinki Univ Hosp, Dept Oncol, Helsinki, Finland.
Ristamäki, Raija (author)
Turku Univ Hosp, Dept Oncol, Turku, Finland.;Univ Turku, Turku, Finland.
Lantto, Eila (author)
Helsinki Univ Hosp, Dept Radiol, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland.;Paijat Home Cent Hosp, Dept Radiol, Lahti, Finland.
Uutela, Aki (author)
Univ Helsinki, Helsinki, Finland.;Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Helsinki, Finland.
Österlund, Emerik (author)
Uppsala universitet,Experimentell och klinisk onkologi,Univ Helsinki, Helsinki, Finland.;Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Helsinki, Finland.;Akad Sjukhuset, Uppsala, Sweden.
Ovissi, Ali (author)
Helsinki Univ Hosp, Dept Radiol, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland.
Nordin, Arno (author)
Univ Helsinki, Helsinki, Finland.;Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Helsinki, Finland.
Heervä, Eetu (author)
Turku Univ Hosp, Dept Oncol, Turku, Finland.;Univ Turku, Turku, Finland.
Lehtomäki, Kaisa (author)
Tampere Univ Hosp, Dept Oncol, Teiskontie 35,POB 2000, Tampere 33520, Finland.;Univ Tampere, Tampere, Finland.
Räsänen, Jari (author)
Univ Helsinki, Helsinki, Finland.;Helsinki Univ Hosp, Dept Thorac Surg, Helsinki, Finland.
Murashev, Maija (author)
Satakunta Cent Hosp, Dept Oncol, Pori, Finland.
Aroviita, Laura (author)
Kanta Hame Cent Hosp, Dept Oncol, Hameenlinna, Finland.
Jekunen, Antti (author)
Vaasa Cent Hosp, Dept Oncol, Vaasa, Finland.
Lindvall-Andersson, Renee (author)
Aland Cent Hosp, Dept Oncol, Mariehamn, Finland.
Nyandoto, Paul (author)
Paijat Name Cent Hosp, Dept Oncol, Lahti, Finland.
Kononen, Juha (author)
Cent Hosp Cent Finland, Dept Oncol, Jyvaskyla, Finland.
Lepistö, Anna (author)
Univ Helsinki, Helsinki, Finland.;Helsinki Univ Hosp, Dept Gastrointestinal Surg, Helsinki, Finland.
Poussa, Tuija (author)
StatConsulting, Nokia, Finland.
Muhonen, Timo (author)
South Carelia Cent Hosp, Dept Oncol, Lappeenranta, Finland.
Ålgars, Annika (author)
Turku Univ Hosp, Dept Oncol, Turku, Finland.;Univ Turku, Turku, Finland.
Isoniemi, Helena (author)
Univ Helsinki, Helsinki, Finland.;Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Helsinki, Finland.
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Karolinska Institutet Tampere Univ Hosp, Dept Oncol, Teiskontie 35,POB 2000, Tampere 33520, Finland;Univ Tampere, Tampere, Finland.;Helsinki Univ Hosp, Dept Oncol, Helsinki, Finland.;Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden. (creator_code:org_t)
Elsevier, 2021
2021
English.
In: The Lancet Regional Health. - : Elsevier. - 2666-7762. ; 3
Related links:
https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Background: Resection of colorectal cancer (CRC) metastases provides good survival but is probably underused in real-world practice. Methods: A prospective Finnish nationwide study enrolled treatable metastatic CRC patients. The intervention was the assessment of resectability upfront and twice during first-line therapy by the multidisciplinary team (MDT) at Helsinki tertiary referral centre. The primary outcome was resection rates and survival. Findings: In 2012-2018, 1086 patients were included. Median follow-up was 58 months. Multiple metastatic sites were present in 500 (46%) patients at baseline and in 820 (76%) during disease trajectory. In MDT assessments, 447 (41%) were classified as resectable, 310 (29%) upfront and 137 (18%) after conversion therapy. Sixhundred and ninety curative intent resections or local ablative therapies (LAT) were performed in 399 patients (89% of 447 resectable). Multiple metastasectomies for multisite or later developing metastases were performed in 148 (37%) patients. Overall, 414 liver, 112 lung, 57 peritoneal, and 107 other metastasectomies were performed. Median OS was 80.4 months in R0/1-resected (HR 0.15; CI95% 0.12-0.19), 39.1 months in R2-resected/LAT (0.39; 0.29-0.53) patients, and 20.8 months in patients treated with "systemic therapy alone" (reference), with 5-year OS rates of 66%, 40%, and 6%, respectively. Interpretation: Repeated centralized MDT assessment in real-world metastatic CRC patients generates high resectability (41%) and resection rates (37%) with impressive survival, even when multisite metastases are present or develop later.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Keyword

Colorectal cancer
Metastatic
Multidisciplinary
Resection
Resectability
Multisite metastases
Conversion

Publication and Content Type

ref (subject category)
art (subject category)

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