Fong's Score in the Era of Modern Perioperative Chemotherapy for Metastatic Colorectal Cancer: A Post Hoc Analysis of the GERCOR-MIROX Phase III Trial.

BACKGROUND: Despite improvement in colorectal liver metastasis (CLM) treatment, survival after liver surgery remains highly variable. Several clinicopathologic prognostic factors have been reported, but their validity in the era of more effective perioperative chemotherapy remains to be defined. The aim of this study is to analyze the prognostic factors associated with survival after CLM resection. METHODS: Clinicopathologic data of patients included in the MIROX phase III trial who underwent surgery for isolated CLMs were analyzed. The primary endpoints were 5-year overall survival (OS) and disease-free survival (DFS). Univariate Cox analysis was performed to identify associations with OS and DFS and select variables for inclusion in a multivariate model to determine their independent prognostic value. RESULTS: A total of 181 patients were analyzed. The median follow-up period was 6.42 years [95% confidence interval (CI) 5.15-8.71 years], and the 5-year OS and DFS rates were 67.1% and 35.4%, respectively. On multivariate analysis, Fong's clinical risk score (CRS) as a categorical variable (CRS 0-1 vs. 2-3 vs. 4-5, p = 0.036) and polymorphonuclear neutrophil (PMN) count (> 6000/mm3 vs. ≤ 6000/mm3, p = 0.006) before chemotherapy were found to be independent prognostic factors for OS. However, only Fong's CRS remained significantly associated with DFS (p = 0.027). The final OS model was used to establish a nomogram that allows individual OS estimations at 1, 3, 5, and 10 years. CONCLUSIONS: Fong's CRS was independently associated with DFS and poor OS after CLM resection with FOLFOX-based chemotherapy regimen. It could be useful in daily practice and future trials to select patients more accurately.

Deep Vein Thrombosis: An Independent Poor Prognosis Factor of Advanced Pancreatic Adenocarcinoma.

BACKGROUND/AIM: Pancreatic adenocarcinoma (PA) is frequently associated with venous thromboembolic events (VTEs). Although the prognostic value of VTEs remains controversial, these events can darken the prognosis. In contrast, because they necessitate anticoagulant therapy, some authors found that VTEs improved the prognosis. Indeed, anticoagulants could have an anti-tumor action. Therefore, we evaluated the prognostic value of VTEs in patients with locally advanced or metastatic PA. PATIENTS AND METHODS: This retrospective study included all patients followed in a medical oncology Department. The prognostic value of tumor parameters, initial patients' characteristics and VTEs were subjected to univariate and multivariate analyses. RESULTS: Based on 142 patients, analyses revealed independent pejorative prognostic value of: VTEs (hazard ratio (HR)=1.49 (95% confidence interval (CI)=1.03-2.15); p=0.03), interval between PA diagnosis and metastases occurrence (HR=0.97 (95% CI=0.94-0.99), p=0.02) and ≥1 metastatic sites (HR=1.82 (95% CI=1.076-3.087), p=0.02). CONCLUSION: VTEs are an independent factor of poor prognosis in patients with advanced PA.

Bevacizumab Associated with Chemotherapy for Initially Non-resectable Liver Metastases from Colorectal Cancer: a Case-Control Study.

BACKGROUND: The place of bevacizumab in therapy of patients with initially non-resectable liver metastases from colorectal cancer (CRC) remains debated. Bevacizumab may increase the efficacy of chemotherapy but it may also maintain dormant micrometastases in a dormant state, eventually increasing the long-term likelihood of tumor relapse. The aim of this study was to explore this hypothesis. PATIENTS AND METHODS: A retrospective case-control study was performed in patients with initially non-resectable CRC liver metastases. Metastases were rendered resectable after chemotherapy with (cases) or without (controls) bevacizumab. Cases and controls were matched for synchronicity, number and maximal size of metastases. The main objective was the disease-free survival (DFS). RESULTS: A total of 82 patients were enrolled (41 in each group). The median DFS was 12.0 months in the bevacizumab group, and 10.2 months in the group treated with chemotherapy alone (p=0.26). CONCLUSION: We observed no significant effect on DFS for bevacizumab when added to chemotherapy in patients with initially non-resectable liver metastases. Prospective trials on this issue are warranted.

Prolonged Survival in a Patient with a Pancreatic Acinar Cell Carcinoma.

Pancreatic acinar cell carcinoma (ACC) is a rare entity. Herein we present the case of a 50-year-old male patient with an unlimited mass on the pancreatic corpus and tail with peripancreatic effusion and multiple metastases in the liver and spleen. A liver biopsy showed a pancreatic ACC. The patient received 9 cycles of gemcitabine plus oxaliplatin (GEMOX regimen), which had to be stopped because of a persistent grade 2 neuropathy. A CT scan showed complete response after 14 years. At the age of 61 years, a localized prostatic cancer was diagnosed, treated by prostatectomy. The patient carried a BRCA2 mutation. None of the precedent case reports describe a chemosensibility to the GEMOX regimen. In spite of the lack of study in these patients, chemotherapy with oxaliplatin seems to be the most effective. Long survival can be expected.