Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2022; 10(8): 2429-2438
Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2429
Prognostic significance of peritoneal metastasis from colorectal cancer treated with first-line triplet chemotherapy
Shouki Bazarbashi, Abdulrahman Alghabban, Mohamed Aseafan, Ali H Aljubran, Ahmed Alzahrani, Tusneem AM Elhassan
Shouki Bazarbashi, Abdulrahman Alghabban, Mohamed Aseafan, Ali H Aljubran, Ahmed Alzahrani, Tusneem AM Elhassan, Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
Author contributions: Bazarbashi S contributed to designing the study; Bazarbashi S, Alghabban A and Aseafan M contributed to data analysis; Bazarbashi S, Alghabban A, Aseafan M, Aljubran AH and Alzahrani A contributed to write the manuscript; Elhassan TA has contributed to the statistical analysis.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board at King Faisal Specialist Hospital and Research Center under the number RAC2081068.
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/ct2/show/NCT01311050?term=bazarbashi&draw=2&rank=4. The registration identification number is: NCT01311050.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and since the study is not randomized trial, the CONSORT 2010 statement do not apply.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shouki Bazarbashi, MBBS, Professor, Oncology Center, King Faisal Specialist Hospital & Research Center, Alzahrawi street, Riyadh 11211, Riyadh, Saudi Arabia. bazarbashi@kfshrc.edu.sa
Received: September 16, 2021
Peer-review started: September 16, 2021
First decision: November 17, 2021
Revised: December 3, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: March 16, 2022
ARTICLE HIGHLIGHTS
Research background

Peritoneal metastasis has been shown to be a poor prognostic factor in metastatic colorectal cancer (CRC). In all published literature citing the above, the patients were treated with either single or doublet first-line chemotherapy. There are no data on the prognostic significance of peritoneal carcinomatosis in patients treated with first-line triplet chemotherapy.

Research motivation

We have shown before that triplet first-line chemotherapy in metastatic CRC overcomes the poor prognosis of right-sidedness. We wanted to examine whether the same applies to peritoneal metastasis in CRC.

Research objectives

We wanted to examine the progression-free survival (PFS) and overall survival (OS) of patients with peritoneal vs no peritoneal metastasis treated with first-line triplet chemotherapy and to confirm the lack of a statistically significant difference in the two groups on univariate and multivariate analysis.

Research methods

This was a post hoc analysis of a phase I/II trial evaluating the efficacy and toxicity of triplet chemotherapy in the first-line treatment of metastatic CRC. Patient characteristics, PFS, and OS were examined for the groups with and without peritoneal metastasis. Univariate and multivariate analyses were performed to include other known prognostic factors in metastatic CRC.

Research results

No statistically significant difference was found in the PFS and OS in the group with or without peritoneal metastasis. Peritoneal metastasis was confirmed not to be an independent prognostic factor in patients with metastatic CRC treated with first-line triplet chemotherapy based on multivariate analysis.

Research conclusions

The study suggests that first-line triplet chemotherapy overcomes the poor prognostic significance of patients with metastatic CRC. This needs to be confirmed in large prospective trials.

Research perspectives

Treatment of patients with metastatic CRC should be personalized based on prognostic clinical and molecular factors. The benefit of triplet chemotherapy might outweigh the excess toxicity in certain subgroups, such as those with peritoneal carcinomatosis.