Tumori Journal Abstract Book - October 2020 - 29

B - Gastrointestinal (Colorectal) Cancers	

29

Molecular Subtypes (CMS) and CRCAssigner (CRCA)
demonstrated prognostic value in multiple studies, but their
predictive role has not been established so far. Given the
poor prognosis associated with early stage mesenchymal/
stem-like subtypes, we hypothesized that the CMS and
CRCA classifiers could predict benefit from the upfront
intensified strategy in patients included in the TRIBE2 study.
Methods: Untreated formalin-fixed paraffin-embedded
samples were classified into CMS and CRCA subtypes
using a custom nCounter assay (NanoString Technologies).
The impact of subtypes on progression free survival (PFS),
progression free survival 2 (PFS2, defined as the time from
randomization until the second evidence of disease progression) or overall survival (OS) was evaluated in the profiled population.
Results: 426 and 428 (63%) patients enrolled in the
TRIBE2 study were profiled according to CMS and CRCA
classifications, respectively. The distribution of CMS and

CRCA subtypes differed according to primary tumour site
(both p<0.001 for CMS/CRCA) and RAS/BRAF mutational status (both p<0.001 for CMS/CRCA). Significant
associations of both CMS and CRCA classifiers with PFS,
PFS2 and OS were demonstrated (Table). The effect of
treatment intensification was independent of CMS subtypes (p for interaction for PFS/PFS2/OS: ns). Significant
interaction effect between CRCA subtypes and treatment
arm was reported in terms of PFS (p=0.017), PFS2
(p=0.010) and OS (p=0.008). The benefit from the intensification of the upfront chemotherapy seemed more relevant in the stem-like (PFS, HR=0.60; p=0.03) and mixed
subtypes (HR=0.44; p=0.002).
Conclusions: CMS subtypes have a prognostic role in
mCRC independently of RAS/BRAF status. CRCA classification may help identifying subgroups of patients who
may derive a more substantial benefit from upfront
FOLFOXIRI plus bev.

CMS1 CMS2 CMS3 CMS4 Enterocyte Goblet-like Inflammatory Stem-like Transitamplifying
Median PFS (months)
5.4
P unadj/adj
Median PFS2 (months) 12.3
P unadj/adj
Median OS (months)
13.7
P unadj/adj

12.9
8.3 10.7
0.0001 / 0.01
19.2
13.7 18.1
0.0004 /0.09
27.0
18.3 26.2
0.0003 / 0.08

10.0

9.9

15.7

16.0

22.3

24.9

B03
The role of primary tumor (PT)
site as prognostic factor after
resection of colorectal (CRC)
liver metastases (LM): a monoinstitutional cohort study
Bensi M.1, Ardito F.2, Di Stefano B.1, Vellone M.2, Vivolo R.1, Mele
C.2, Ribelli M.1, Panettieri E.2, Camarda F.1, Frascarelli A.2, Calegari
M.A.1, Basso M.1, Pozzo C.1, Giuliante F.2, Tortora G.1, Salvatore L.1
1
Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico
Universitario Agostino Gemelli - IRCCS. Università Cattolica del Sacro Cuore,
Roma; 2Chirurgia Epato-biliare, Comprehensive Cancer Center, Fondazione
Policlinico Universitario Agostino Gemelli - IRCCS. Università Cattolica del
Sacro Cuore, Roma

Background: Radical resection of LM is the only chance
of cure for liver-only mCRC pts. Besides the evaluation of
technical resectability, several factors must be taken into
account for the evaluation of recurrence risk. Among them
we should consider the Fong Risk Score and its modified
version, including RAS/BRAF status (Brudvik's score).
Tumor sidedness is an important prognostic factor in CRC.
The impact of PT site on the outcome of LM resection is
still debated. We retrospectively analysed mCRC pts,

7.9
14.6
0.04 / 0.36
12.2
24.0
0.04 / 0.37
19.8
31.3
0.02 / 0.55

Mixed

11.2

9.9

18.1

16.5

25.6

21.0

underwent to radical LM resection at our Institution, investigating the impact of PT site on DFS and OS.
Methods: Liver-only mCRC pts underwent to radical LM
resection were included. The association of PT site with
DFS and OS was evaluated. The following variables were
collected: gender; age; ECOG PS; CEA baseline level; PT
site; RAS and BRAF status; mucinous histology; grading;
RECIST response during preoperative treatment; resected
PT; synchronous vs metachronous; number of LM; bilobar vs unilobar LM; LM diameter; R0 vs R1 resection.
Univariate and multivariate analyses for DFS and OS
were performed.
Results: A total of 463 liver-only mCRC pts underwent to
radical LM resection were included. Seventy (15%) pts
had a right-sided (r-s) tumor and 393 (85%) pts a left-sided
(l-s) tumor. R-s CRC pts more often had RAS/BRAF
mutations in comparison to l-s tumors (76% vs 37%; p <
0.0001). Median DFS and OS was 13.1 and 41.6 months in
r-s CRC vs 16.0 (p=0.65) and 62.2 months (p=0.033) in l-s
tumors. At the multivariate analysis no significant association with survival parameters was shown for tumor sidedness. At the multivariate analysis, R0 resection was
independently associated both with better DFS and OS;
RAS/BRAF wt CRC and resected PT were significantly
associated with improved OS. Considering all wt CRC pts



Tumori Journal Abstract Book - October 2020

Table of Contents for the Digital Edition of Tumori Journal Abstract Book - October 2020

Contents
Tumori Journal Abstract Book - October 2020 - Cover1
Tumori Journal Abstract Book - October 2020 - Cover2
Tumori Journal Abstract Book - October 2020 - I
Tumori Journal Abstract Book - October 2020 - II
Tumori Journal Abstract Book - October 2020 - Contents
Tumori Journal Abstract Book - October 2020 - IV
Tumori Journal Abstract Book - October 2020 - V
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Tumori Journal Abstract Book - October 2020 - Cover3
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