The role of molecular biomarkers in outcomes and patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases of colorectal origin

Daniel Solomon, Natasha Leigh, Eliahu Bekhor, Yael Feferman, Poojaben Dhorajiya, Daniela Feingold, Margaret Hofstedt, Samantha N. Aycart, Benjamin J. Golas, Umut Sarpel, Daniel M. Labow, Deepa R. Magge

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is effective in select patients with peritoneal metastases of colorectal (CRC) origin. The impact of different biomarkers in predicting recurrence after CRS/HIPEC is unclear. Methods: Retrospective review of patients who underwent CRS/HIPEC for PC of CRC origin from 03/2007–08/2017. Molecular profile of the primary tumor was obtained from pathology reports, whenever available. Results: Overall, 100 patients underwent CRS/HIPEC for peritoneal metastases of CRC origin. Most patients presented high grade tumor histology (G2/G3, n = 97, 97%), and a majority showed mucinous features (n = 61, 61%). At a median follow-up of 18 months, median DFS for the overall population was 13 months (95% CI 9.6, 16.4). Data reporting at least one mutational analysis was available in 64 patients. Microsatellite stability was detected in 42/50 (84%) patients, mKRAS in 25/51 (49%), and mBRAF in 5/35 (14.3%). On Kaplan–Meier analysis, BRAF was the only mutation associated with poor DFS (16 months, CI 95% 11.7–43.3 vs. 7 months, CI 95% 2.1–11.9, p = .008). On multivariate analysis, mBRAF independently predicted earlier recurrence (p = .032). Conclusions: In this analysis, mBRAF was independently associated with earlier recurrence in patients undergoing CRS/HIPEC for CRC, leading to dismal median DFS (7 months). Strict patient selection is advisable in these patients.

Original languageEnglish
Pages (from-to)e379-e385
JournalSurgeon
Volume19
Issue number6
DOIs
StatePublished - Dec 2021
Externally publishedYes

Keywords

  • Colorectal cancer
  • CRS/HIPEC
  • Mutational status
  • Peritoneal carcinomatosis

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