Predictive Profile Of Survival Beneficiary From Maintenance Treatment Of Metastatic Colorectal Cancer

Objective: Maintenance treatment, which with low toxicity and high efficiency, has been widely applied for metastatic colorectal cancer(mCRC).But the profile of candidates who can benefit from this strategy remains unclear. Personalized therapy may further improve patient survival and quality of life. This study aimed to investigate patient characteristics and determine the optimal survival beneficiary.Methods: From February 2007 to October 2014, we reviewed clinicopathological data of 274 mCRC patients who received first-line chemotherapy and 49 patients who received second-line chemotherapy in Tianjin Medical University Cancer Hospital. SPSS statistical software was used for statistical analysis. ROC curve was calculated to determine the optimal cut-off value for the variable with no standard value. The end point was progression free survival(PFS), including PFS1 and PFS2. PFS1 was defined as the period starting from the date of chemotherapy up to the first observation of disease progression or death from any cause. If a patient had not reached the progression endpoint, PFS was regarded at the last follow-up. PFS2 started with the end of induction chemotherapy.Results: 1.For the patients with first-line chemotherapy, primary site, baseline CA19-9 level and its dynamic change, Prognostic nutrional index, treatment after induction chemotherapy were prognostic factors of PFS1. And baseline CA19-9 level and its dynamic change, Prognostic nutrional index, treatment after induction chemotherapy were prognostic factors of PFS2. Multivariate analysis demonstrated that baseline CA19-9 level and its dynamic change, treatment after induction chemotherapy were independent prognostic factors for PFS1 and PFS2.In the subgroup of patients with maintenance treatment, low CA19-9 level, transient CA19-9 surge post-chemotherapy and more than five maintenance cycles predicted long-term PFS1 and PFS2. A low PNI level was the other predictive factor for prolonged PFS2. In the subgroup of patients with low PNI level, only patients undergoing maintenance treatment experienced prolonged PFS1. In the subgroup of patients with low baseline CA19-9 level, maintenance treatment was an independent prognostic factors for PFS1 and PFS2.2. Maintenance treatment was a suitable and efficient option for the patients achieving second-line chemotherapy.3. The level of CA19-9 and PLR, treatment after chemotherapy were significant prognostic factors for mCRC patients who achieved stable disease after induction chemotherapy. These patients could get benefit from maintenance treatment, especially for the patients with high PLR.Conclusions: Maintenance treatment could prolong the survival of metastatic colorectal cancer patients, who had achieved first or second line chemotherapy. After first-line induction chemotherapy, patients with low level of CA19-9 could get more benefit from the maintenance treatment. In the patients with stable disease, maintenance treatment can improve the survival,especially for those with high PLR, a subgroup with poor prognosis.