Urgent need for a new staging system in advanced colorectal cancer.
Despite recent advances in the medical treatment of metastatic colorectal cancer (mCRC), which include irinotecan- and oxaliplatin-based first-line regimens, the concept of planned sequential therapy involving three active agents during the course of a patient's treatment and the increasing use of targeted monoclonal antibodies, 5-year survival rates for patients with advanced CRC remain unacceptably low. For patients with CRC liver metastases, liver resection remains the only chance of cure, with 5-year survival rates ranging from 25% to 40%. However, 80% to 85% of patients with stage IV CRC have liver disease which is considered unresectable at presentation. The rapid expansion in the use of improved combination chemotherapy regimens plus or minus biologics, to render initially unresectable metastases resectable has increased the percentage of patients eligible for potentially curative surgery. However, the current staging criteria for CRC patients with metastatic disease do not reflect these recent changes or the fact that there is also a large variation in the survival of patients with stage IV CRC. For example the survival for a patient with a solitary, resectable liver metastasis is better than that for a patient with stage III disease. A new staging system is therefore needed that acknowledges both the improvements that have been made in surgical techniques for resectable metastases and the impact of modern chemotherapy on rendering initially unresectable CRC liver metastases resectable, while at the same time distinguishing between patients with a chance of cure at presentation and those for whom only palliative treatment is possible.
Poston
Graeme J
GJ
Department of Surgery, University Hospital Aintree, Liverpool, L9 7AL, United Kingdom. graeme.poston@aintree.nhs.uk
Figueras
Joan
J
Giuliante
Felice
F
Nuzzo
Gennaro
G
Sobrero
Alberto F
AF
Gigot
Jean-Francois
JF
Nordlinger
Bernard
B
Adam
Rene
R
Gruenberger
Thomas
T
Choti
Michael A
MA
Bilchik
Anton J
AJ
Van Cutsem
Eric J D
EJ
Chiang
Jy-Ming
JM
D'Angelica
Michael I
MI
D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D009367:Neoplasm Staging / Q000379:methods*; D016019:Survival Analysis