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, Salminen Tapio, Soveri Leena-Maija, Kallio Raija, Kellokumpu Ilmo, Lamminmäki Annamarja, Halonen Päivi, Ristamäki Raija, Lantto Eila, Uutela Aki, Osterlund Emerik, Ovissi Ali, Nordin Arno, Heervä Eetu, Lehtomäki Kaisa, Räsänen Jari, Murashev Maija, Aroviita Laura, Jekunen Antti, Lindvall-Andersson Reneé, Nyandoto Paul, Kononen Juha, Lepistö Anna, Poussa Tuija, Muhonen Timo, Ålgars Annika, Isoniemi Helena
Publisher: ELSEVIER
: 2021
: Lancet regional health - Europe
: LANCET REG HEALTH-EU
: ARTN 100049
: 3
: 12
: 2666-7762
: 2666-7762
DOI: https://doi.org/10.1016/j.lanepe.2021.100049
: https://www.sciencedirect.com/science/article/pii/S2666776221000260?via%3Dihub
: https://research.utu.fi/converis/portal/detail/Publication/66390160
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.
