Impact of Liver Directed Therapy in Colorectal Cancer Liver Metastases

Details

• Alternative Title:
  J Surg Res
• Personal Author:
  Vargas, Gabriela M. ; Parmar, Abhishek D. ; Sheffield, Kristin M. ; Tamirisa, Nina P. ; Brown, Kimberly M. ; Riall, Taylor S.
• Description:
  Background
  
  There is a paucity of data on the current management and outcomes of liver directed therapy (LDT) in older patients presenting with stage IV colorectal cancer (CRC).
  
  Objective
  
  To evaluate treatment patterns and outcomes in use of LDT in the setting of improved chemotherapy.
  
  Methods
  
  We used Cancer Registry and linked Medicare claims to identify patients ≥66 undergoing surgical resection of the primary tumor and chemotherapy after presenting with stage IV CRC (2001–2007). LDT was defined as liver resection and/or ablative procedures.
  
  Results
  
  We identified 5,500 patients. LDT was used in 34.9% of patients; liver resection was performed in 1,686 patients (30.7%) and locoregional therapy in 554 patients (10.1%), with 322 patients having both resection and ablation/embolization. Use of LDT was negatively associated with increasing year of diagnosis (OR=0.96, 95% CI 0.93–0.99), age >85 (OR=0.61, 95% CI 0.45–0.82), and poor tumor differentiation (OR=0.73, 95% CI 0.64–0.83). LDT was associated with improved survival (median 28.4 vs. 21.1 months, P<0.0001); however, survival improved for all patients over time. We found a significant interaction between LDT and time period of diagnosis and noted a greater survival improvement with LDT for those diagnosed in the late (2005–2007) time period.
  
  Conclusions
  
  Older patients with stage IV CRC are experiencing improved survival over time independent of age, comorbidity and use of LDT. Greater gains in survival are seen with LDT for patients diagnosed in the later time period. These data suggest that improved patient selection may be positively impacting outcomes.
  
  
• Subjects:
  Adenocarcinoma Aged Aged, 80 And Over Antimetabolites, Antineoplastic Catheter Ablation Colorectal Neoplasms Combined Modality Therapy Disease-Free Survival Embolization, Therapeutic Female Fluorouracil Humans International Classification Of Diseases Kaplan-Meier Estimate Leucovorin Liver Neoplasms Male Medicare Neoplasm Staging Proportional Hazards Models Registries Vitamin B Complex

  More +
• Source:
  J Surg Res. 2014; 191(1):42-50.
• Pubmed ID:
  24990539
• Pubmed Central ID:
  PMC4134714
• Document Type:
  Journal Article
• Funding:
  T32 DK007639/DK/NIDDK NIH HHS/United States ; R24 HS022134/HS/AHRQ HHS/United States ; N02 PC015105/PC/NCI NIH HHS/United States ; UL1 TR000071/TR/NCATS NIH HHS/United States ; N01PC35136/CA/NCI NIH HHS/United States ; N01PC35139/CA/NCI NIH HHS/United States ; U58 DP000824/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  191
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:05d6c311b52a76bfa1e8444975f8b63e2bb027743075af3830885e161a7b0706
• Download URL:
  https://stacks.cdc.gov/view/cdc/41979/cdc_41979_DS1.pdf
• File Type:
  [PDF - 822.38 KB ]