Anne von Ruesten

Purpose: Colorectal cancer is the third most common cancer worldwide, with 15–25% of patients presenting synchronous liver metastases (UICC stage IV). Surgical resection remains crucial, but the optimal sequence for managing synchronous metastases is debated. This study evaluates the impact of different surgical strategies on survival in colorectal cancer patients with liver-only metastases (CRLM) and identifies factors influencing mortality. Methods: This retrospective cohort study analyzed CRLM patients from German cancer registries in Brandenburg and Berlin from 2017 to 2022, grouped by surgical treatment sequence: simultaneous primary tumor resection (PTR) and liver resection, PTR before liver resection, or liver resection before PTR. Kaplan-Meier and Cox regression analyses evaluated overall survival (OS) and the impact of systemic therapy and patient characteristics. Results: Among 23,394 colorectal cancer patients, 209 met inclusion criteria. Simultaneous resection was performed in 45% (N = 93), PTR before liver resection in 43% (N = 90), and liver resection first in 12% (N = 26). PTR before liver resection showed the best 5-year OS (68% vs. 53% for simultaneous surgery; HR 0.44, 95% CI = 0.22–0.88, p = 0.020). Simultaneous resection had the highest 30-day mortality (6.5%, N = 6). Postoperative chemotherapy significantly improved 5-year OS (66% vs. 57% for no chemotherapy; HR 0.45, 95% CI = 0.22–0.95, p = 0.036). Excluding 30-day mortality, survival differences diminished. Conclusion: Primary tumor resection before liver resection appears to improve long-term survival in CRLM patients. Simultaneous resection should be carefully considered due to increased mortality, particularly in older patients with lower performance status undergoing major liver surgery. Postoperative chemotherapy enhances survival, emphasizing the need for tailored treatment strategies.

Background: Medical care structures differ between urban and rural areas. Clinical cancer registries can depict real-world care through detailed data analysis, identifying potential regional disparities and contributing to improvements in healthcare. Methods: Data from the Brandenburg–Berlin Clinical-Epidemiological Cancer Registry for the years of diagnosis 2017–2022 were analyzed to assess the epidemiology and real-world care of gastric cancer, including cardia. Brandenburg was compared to Berlin regarding perioperative treatment regimens. The resulting survival benefits were assessed using Kaplan–Meier and Cox regression models. Results: For the years of diagnosis 2017 to 2022, 5805 cases of gastric carcinoma were documented in the cancer registry. Survival data showed no significant differences between Berlin and Brandenburg. Preoperative therapy for cT3/cT4N0 tumors was significantly more common in Berlin (72%) than in Brandenburg (68%). Perioperative therapy was associated with a survival benefit for stages T3-/T4N+ but not for stages T1N+ or T2. The lower proportion of pre-treated T3/T4N+ patients in rural Brandenburg did not result in a significant survival difference. Conclusions: The data provide a comprehensive representation of the current state of gastric cancer care in these two regions. Gastric cancer treatment outcomes, in terms of survival, are comparable between the rural region of Brandenburg and the urban center of Berlin.

Objective: To compare the survival of palliative stage IV colorectal cancer patients selected for primary tumor resection and systemic treatment (PTR+SYST) to patients with systemic treatment only (SYST). Background: About 20–25% of all colorectal cancer patients are diagnosed with stage IV disease. The benefit of primary tumor resection in the palliative situation is therefore of high concern. However, empirical evidence from randomized and observational studies is inconsistent. Methods: Mortality after PTR+SYST was compared to systemic treatment alone in a retrospective observational cohort of patients diagnosed 2012–2020 from the cancer registry in the federal state of Brandenburg (Germany), excluding patients with rectal cancer of the lower two-thirds, emergency procedures, unknown ECOG status, ECOG greater than 2, unknown metastatic status or unclear grading. Results: Of 480 patients, 416 died during an average follow-up of 23 months in mean. Twelve-month survival was 75% after PTR+SYST compared with 49% after SYST [hazard ratio (HR)=0.39, 95% CI 0.29–0.53, PP<0.001). Results were similar after multivariate adjustment, propensity score matching and delayed entry. Conclusion and relevance: Patients with stage IV colorectal carcinoma who are selected for primary tumor resection in combination with systemic therapy and who receive such treatment survive longer compared with patients who receive only systemic treatment. Whether the difference is due to the selection of patients or PTR remains unclear. At present, the current practice of selecting patients for PTR appears to do no harm.

Background: The current therapy of ovarian cancer is based on the so-called “Three-Pillar-Model”, consisting of surgery, chemotherapy and maintenance therapy. This study represents the first major analysis of a federal cancer database of OC patients from the states Berlin/Brandenburg in Germany. The primary objective was to evaluate the prevailing established quality indicators surgical outcome, adjuvant chemotherapy and integrity of surgical staging in early stages. Methods: Data from the Clinical Cancer Registry for Brandenburg and Berlin of the years 2009–2019 were analyzed. Objectives were defined by a working group of selected physicians. Descriptive statistics were performed, as well as survival analysis. Results: A total of 2771 primary OC cases were included. Results regarding histological subtype met the suspected allocation with predominantly high-grade serous OC in advanced stage. The rate of complete surgical staging in FIGO stages I–IIA was 57%, and the rate of macroscopic complete resection in >FIGO III was 53%. Five-year survival rate varied from 79% (FIGO I) to 40% (FIGO III). Rate of adjuvant chemotherapy was above 50%. Conclusion: The results elucidate quality measurements and treatment results and show good treatment outcomes in patients with primary diagnosis. However, they also indicate deficits and can help to establish new quality indicators to further improve the treatment.