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Clinical and genetic determinants of ovarian metastases from colorectal cancer
Author(s) -
Ganesh Karuna,
Shah Ronak H.,
Vakiani Efsevia,
Nash Garrett M.,
Skottowe Hugh P.,
Yaeger Rona,
Cercek Andrea,
Lincoln Anne,
Tran Christina,
Segal Neil H.,
Reidy Diane L.,
Varghese Anna,
Epstein Andrew S.,
Sonoda Yukio,
Chi Dennis,
Guillem Jose,
Temple Larissa,
Paty Philip,
Hechtman Jaclyn,
Shia Jinru,
Weiser Martin,
Aguilar Julio Garcia,
Kemeny Nancy,
Berger Michael F.,
Saltz Leonard,
Stadler Zsofia K.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30424
Subject(s) - medicine , kras , colorectal cancer , oncology , cancer , ovarian cancer , metastasis , lynch syndrome , dna mismatch repair
BACKGROUND Ovarian metastases from colorectal cancer (OM‐CRC) often are unresponsive to chemotherapy and are associated with poor survival. To the authors' knowledge, the clinicopathologic and genomic predictors of OM‐CRC are poorly characterized and optimal clinical management remains unclear. METHODS Women with a histopathological diagnosis of OM‐CRC who were treated at Memorial Sloan Kettering Cancer Center from 1999 to 2015 were identified. Next‐generation somatic mutation profiling (Memorial Sloan Kettering‐Integrated Mutation Profiling of Actionable Cancer Targets [MSK‐IMPACT]) was performed on 38 OM‐CRC cases, including 21 matched tumor pairs/trios. Regression models were used to analyze variables associated with progression‐free survival and overall survival (OS). RESULTS Kirsten Rat Sarcoma Viral Oncogene Homolog ( KRAS ), SMAD family member 4 ( SMAD4 ), and neurotrophic receptor tyrosine kinase 1 ( NTRK1 ) mutations were more frequent in cases of OM‐CRC than in instances of CRC occurring without OM. SMAD4 and lysine methyltransferase 2D ( KMT2D ) mutations were associated with reduced OS. Matched multisite tumor sequencing did not identify OM‐specific genomic alterations. Of the 195 patients who underwent oophorectomy for OM‐CRC (median age, 49 years with a progression‐free survival of 9.4 months and an OS of 23 months from oophorectomy), 76% had extraovarian metastasis (EOM). In multivariable analysis, residual disease after surgery (R2 resection) was associated with worse survival. Patients with EOM were less likely to achieve R0/R1 surgical resection status (complete macroscopic resection without clinical/radiological evidence of disease) (48% vs 94%). However, if R0/R1 resection status was achieved, both patients with (35.9 months vs 12 months) and without (43.2 months vs 14.5 months) EOM were found to have better OS. Among 114 patients with R0/R1 resection status, 23 (20%) had no disease recurrence, including 10 patients (9%) with > 3 years of follow‐up. CONCLUSIONS Loss‐of‐function alterations in SMAD4 are frequent and predictive of worse survival in patients with OM‐CRC. Similar to oligometastatic CRC to the lung or liver, surgical resection of OM‐CRC is associated with a better outcome only if all macroscopic metastatic disease is resected. Cancer 2017;123:1134–1143. © 2016 American Cancer Society .