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

Pia Osterlund; Tapio Salminen, MD; Leena-Maija Soveri, MD; Raija Kallio, MD; Ilmo Kellokumpu, MD; Annamarja Lamminmäki, MD; Päivi Halonen, MD; Raija Ristamäki, MD; Eila Lantto, MD; Aki Uutela, MD; Emerik Osterlund, MD; Ali Ovissi, MD; Arno Nordin, MD; Eetu Heervä, MD; Kaisa Lehtomäki, MD; Jari Räsänen, MD; Maija Murashev, MD; Laura Aroviita, MD; Antti Jekunen, Prof; Reneé Lindvall-Andersson, MD; Paul Nyandoto, MD; Juha Kononen, MD; Anna Lepistö, MD; Tuija Poussa, MSc; Timo Muhonen, MD; Annika Ålgars, MD; Helena Isoniemi, Prof

The Lancet Regional Health. Europe (Apr 2021)

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

Pia Osterlund,
Tapio Salminen, MD,
Leena-Maija Soveri, MD,
Raija Kallio, MD,
Ilmo Kellokumpu, MD,
Annamarja Lamminmäki, MD,
Päivi Halonen, MD,
Raija Ristamäki, MD,
Eila Lantto, MD,
Aki Uutela, MD,
Emerik Osterlund, MD,
Ali Ovissi, MD,
Arno Nordin, MD,
Eetu Heervä, MD,
Kaisa Lehtomäki, MD,
Jari Räsänen, MD,
Maija Murashev, MD,
Laura Aroviita, MD,
Antti Jekunen, Prof,
Reneé Lindvall-Andersson, MD,
Paul Nyandoto, MD,
Juha Kononen, MD,
Anna Lepistö, MD,
Tuija Poussa, MSc,
Timo Muhonen, MD,
Annika Ålgars, MD,
Helena Isoniemi, Prof

Affiliations

Pia Osterlund: Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital, Helsinki, Finland; Department of Oncology/Pathology, Karolinska Insitutet and Karolinska University Hospital, Stockholm, Sweden; Corresponding author. Department of Oncology, Tampere University Hospital, Teiskontie 35, PO Box 2000, 33520 Tampere, Finland
Tapio Salminen, MD: Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
Leena-Maija Soveri, MD: Department of Oncology, Helsinki University Hospital, Helsinki, Finland; Department of palliative care, Hyvinkää Hospital and Home Care, Hyvinkää, Finland
Raija Kallio, MD: Department of Oncology, Oulu University Hospital and University of Oulu, Oulu, Finland
Ilmo Kellokumpu, MD: Department of Gastrointestinal Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
Annamarja Lamminmäki, MD: Department of Oncology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland
Päivi Halonen, MD: Department of Oncology, Helsinki University Hospital, Helsinki, Finland
Raija Ristamäki, MD: Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
Eila Lantto, MD: Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Radiology, Päijät-Häme Central Hospital, Lahti, Finland
Aki Uutela, MD: Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Emerik Osterlund, MD: Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Immunology, Genetics and Pathology, Uppsala University and Akademiska sjukhuset, Uppsala, Sweden
Ali Ovissi, MD: Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Arno Nordin, MD: Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Eetu Heervä, MD: Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
Kaisa Lehtomäki, MD: Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
Jari Räsänen, MD: Department of Thoracic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Maija Murashev, MD: Department of Oncology, Satakunta Central Hospital, Pori, Finland
Laura Aroviita, MD: Department of Oncology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
Antti Jekunen, Prof: Department of Oncology, Vaasa Central Hospital, Vaasa, Finland
Reneé Lindvall-Andersson, MD: Department of Oncology, Aland Central Hospital, Mariehamn, Finland
Paul Nyandoto, MD: Department of Oncology, Päijät-Häme Central Hospital, Lahti, Finland
Juha Kononen, MD: Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
Anna Lepistö, MD: Department of Gastrointestinal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Tuija Poussa, MSc: StatConsulting, Nokia, Finland
Timo Muhonen, MD: Department of Oncology, South Carelia Central Hospital, Lappeenranta, Finland
Annika Ålgars, MD: Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
Helena Isoniemi, Prof: Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

Journal volume & issue: Vol. 3
p. 100049

Abstract

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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. Six-hundred 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. Funding: The funders had no role in the study design, analysis, and interpretation of the data or writing of this report.

Published in The Lancet Regional Health. Europe

ISSN: 2666-7762 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanepe/home

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