Published online Feb 16, 2023. doi: 10.4253/wjge.v15.i2.64
Peer-review started: November 29, 2022
First decision: December 19, 2022
Revised: December 28, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: February 16, 2023
Processing time: 75 Days and 22.1 Hours
Stenting as a bridge to curative surgery (SBTS) for obstructing colon cancer (OCC) has been associated with possibly worse oncological outcomes.
To evaluate the recurrence patterns, survival outcomes, and colorectal cancer (CRC)-specific death in patients undergoing SBTS for OCC.
Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined. Primary outcomes were recurrence patterns, overall survival (OS), cancer-specific survival (CSS), and CRC-specific death. OS and CSS were estimated using the Kaplan-Meier curves. Competing risk analysis with cumulative incidence function (CIF) was used to estimate CRC-specific mortality with other cause-specific death as a competing event. Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death. Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.
28 patients (45.2%) developed metastases after a median period of 16 mo. Among the 18 patients with single-site metastases: Four had lung-only metastases (14.3%), four had liver-only metastases (14.3%), and 10 had peritoneum-only metastases (35.7%), while 10 patients had two or more sites of metastatic disease (35.7%). The peritoneum was the most prevalent (60.7%) site of metastatic involvement (17/28). The median follow-up duration was 46 mo. 26 (41.9%) of the 62 patients died, of which 16 (61.5%) were CRC-specific deaths and 10 (38.5%) were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%; 1-, 3-, and 5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mo was liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictive of CRC-specific death.
The peritoneum was the most common metastatic site among patients undergoing SBTS. Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors of CRC-specific death.
Core Tip: This is the first retrospective study with a 10-year period using the competing risk analysis of cumulative incidence function to evaluate survival and estimate colorectal cancer (CRC)-specific death based on the Fine-Gray model in patients undergoing stenting as a bridge to curative surgery (SBTS) for obstructing colon cancer (OCC). The duration of this study allows a thorough examination of the long-term oncological outcomes of SBTS, survival rates, recurrence patterns, and prognostic factors contributing to CRC-specific death. Our results showed that liver-only recurrence, peritoneum-only recurrence, and more than two recurrence sites are significantly associated with poor survival and prognostic factors for CRC-specific death in patients undergoing SBTS for OCC.