Colorectal Sarcomatoid Carcinoma: a Rare Condition with Poor Outcomes
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RESEARCH COMMUNICATION
Colorectal Sarcomatoid Carcinoma: a Rare Condition with Poor Outcomes Vanessa M. Welten 1
&
Pamela W. Lu 1,2 & Adam C. Fields 1 & James Yoo 1 & Nelya Melnitchouk 1,2
Received: 14 June 2020 / Accepted: 22 June 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Colorectal . Sarcomatoid carcinoma . Outcomes . Survival
Introduction Colorectal sarcomatoid carcinoma is a rare disease with distinct carcinomatous and sarcomatoid components, and there 1 are few reported cases reported in the literature. –3 It is characterized by rapid tumor growth and early metastasis, with 1 median survival estimated at less than 6 months. , 2, 4 There are no evidence-based treatment guidelines, and prior cases 5 have been managed similarly to colonic adenocarcinomas. We aim to use a large national database to better describe disease characteristics and survival for this rare disease entity.
Materials and Methods The National Cancer Database (NCDB) was queried to identify patients with primary colorectal sarcomatoid carcinoma between 2004 and 2016. The study was exempt by the Brigham and Women’s Hospital Institutional Review Board. The primary outcome was overall survival. Survival was calculated using the Kaplan-Meier method. Survival between patients who underwent surgery and to those who did not was compared using log rank tests. Patients with missing Vanessa M. Welten and Pamela W. Lu are the co-first authors. This work was presented as an e-poster at the virtual American Society of Colon and Rectal Surgeons Annual Meeting, June 6–10, 2020.
survival or surgical treatment information were excluded from respective analyses. Two-sided p values < 0.05 were considered statistically significant. All statistical analyses were performed using STATA, version 14.1 (StataCorp, College Station, Tx: StataCorp LLC).
Results A total of 75 patients with colorectal sarcomatoid carcinoma were identified. Patient, disease, and treatment characteristics are summarized in Table 1. The majority of patients were male (61%), aged greater than 70 (52%), white (87%), and with no comorbidities (73%). Fifty-nine (79%) patients had primary disease in the colon, and 14 (19%) had primary disease in the rectum. Twenty-five (33%) patients had stage 4 disease at diagnosis, and 32 (43%) had unknown stage of disease. Twenty-seven (36%) patients underwent chemotherapy, and 9 (12%) underwent radiation. Of the 14 patients with rectal sarcomatoid carcinoma, 7/14 (50%) underwent radiation, 8/14 (57%) underwent chemotherapy, and 5/14 (36%) underwent chemoradiation. Forty-four (59%) patients underwent surgery, 10 (23%) of whom had positive margins. Survival data is presented in Fig. 1. One-year overall survival was 22% (95% CI 13%–33%) (Fig. 1a). Median survival was 3.5 months (95% CI 2.37–4.63). There was no difference in unadjusted survival of patients who underwent surgery compared with those who did not, p = 0.55 (Fig. 1b).
* Vanessa M. Welten [email protected]
Discussion 1
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Department of Surgery, Division of General
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