Is primary tumour resection associated with survival improvement in patients with colorectal cancer and unresectable synchronous metastases? A pooled analysis of individual data from four randomised trials

Faron, Matthieu; Pignon, Jean-Pierre; Malka, David; Bourredjem, Abderrahmane; Douillard, Jean-Yves; Adenis, Antoine; Élias, Dominique; Bouché, Olivier; Ducreux, Michel

doi:10.1016/j.ejca.2014.10.023

Cited by 121 publications

(85 citation statements)

References 42 publications

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“…Some retrospective studies [15][16][17] have suggested that PTR may also provide a survival benefit. Kim et al [18] reported that mCRC patients who underwent PTR followed by chemotherapy had significantly longer survival times than patients who received chemotherapy as the first line of treatment, but only 13.9% and 17.5% mCRC patients received bevacizumab in the two cohorts in their study.…”

Section: Discussionmentioning

confidence: 99%

Primary Tumour Resection Could Improve the Survival of Unresectable Metastatic Colorectal Cancer Patients Receiving Bevacizumab-Containing Chemotherapy

Wang

Liang

et al. 2016

Cell Physiol Biochem

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Background: The effect of primary tumour resection (PTR) among metastatic colorectal cancer (mCRC) patients remains controversial. Combination chemotherapy with bevacizumab could improve the clinical outcomes of these patients, which might change the importance of PTR in the multi-disciplinary treatment pattern. Methods: We performed a non-randomized prospective controlled study of mCRC pts whose performance status (PS) scored ≤2 and who received bevacizumab combination chemotherapy (FOLFOX/XELOX/FOLFIRI) as a first-line therapy. These patients were classified into the PTR group and the IPT (intact primary tumour) group according to whether they underwent PTR before receiving the systemic therapy. The progression free survival (PFS) time and overall survival (OS) time, which were recorded from the start of the primary diagnosis until disease progression and death or last follow-up, were analysed. We also compared severe clinical events (such as emergency surgery, radiation therapy, and stent plantation) between the two groups. Results: One hundred and nighty-one mCRC pts (108 male patients and 93 female patients) were entered in this prospective observational study. The median age was 57.5 years old. The clinical characteristics (age, gender, performance status, primary tumour site, RAS status, and the number of metastatic organs) did not significantly differ between the two groups. The median PFS and OS times of the PTR group were superior than those of the IPT group (10.0 vs 7.8 months, p < 0.01 and 22.5 vs 17.8 months, p < 0.01, respectively). The incidences of adverse events associated with systemic therapy were similar between the two groups. Specifically, sixteen patients (21.9%, 16/73) with IPT developed significant primary tumour-related complications, such as bleeding, obstruction or even perforation. Among these patients, five underwent emergency surgery, three patients received a stent, and eight patients underwent radiation therapy. Conclusions: The mCRC patients who received PTR and bevacizumab combination chemotherapy had better clinical outcomes than patients who did not receive PTR. PTR also decreased the incidence of severe clinical events and improved quality of life.

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Section: Discussionmentioning

confidence: 99%

Primary Tumour Resection Could Improve the Survival of Unresectable Metastatic Colorectal Cancer Patients Receiving Bevacizumab-Containing Chemotherapy

Wang

Liang

et al. 2016

Cell Physiol Biochem

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“…The efficacy of primary resection for asymptomatic unresectable disease remains controversial [4][5][6][7] . In this study, although 52% of the non-R0/1 group had symptomatic primary disease and 60% underwent primary resection, the primary resection improved survival significantly in the non-R 0/1 group; however, notably, this study is a small retrospective study and included selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical resection with perioperative chemotherapy is recommended as a promising option of the treatment for initially resectable disease, including distant metastasis 3) . Alternatively, no contrary opinion exists against the main role of systemic chemotherapy for initially unresectable disease, although the role of primary tumor resection remains controversial [4][5][6][7] . The judgment of resectability is an important issue but remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Early liver metastasis after curative resection including stage IV disease has been reported to be a worse prognostic factor [11][12][13] . Faron et al reported that 30% of the registered patients had metachronous recurrence in the four large European randomized controlled trials (RCTs) 7) . The true outcome of the pure stage IV patients remained unclear.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of stage IV patients with colorectal cancer treated in a single institution: What is the key to the long-term survival?

Mukai

Uehara

Aiba

et al. 2018

J Anus Rectum Colon

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Abstract:Objectives: The purpose of this study is to summarize our short-and long-term treatment results for stage IV colorectal cancer (CRC) and to clarify the factors predicting the favorable long-term survival. Methods: Between January 2008 and December 2015, 149 consecutive patients with stage IV CRC underwent initial treatment at Nagoya University Hospital. Their clinical and pathological characteristics, the treatment methods used, and the outcomes were retrospectively analyzed. Results: The median observation period was 23 months. All of the primary and metastatic lesions were technically resectable in 74 patients; however, the remaining 75 were judged as initially unresectable. R0/1 resection during the treatment course was achieved in 74 patients (50%). For the cohort as a whole, the 5-year overall survival (OS) rate was 35%. The 5-year OS rate in the R0/1 resection group was 57%, which was significantly better than that of the non-R0/1 resection group (6%, p < 0.001). In the R0/1 resection group, perioperative chemotherapy significantly improved the outcome (5-year OS; 62% vs. 0%, p = 0.03). In the non-R0/1 resection group, primary tumor resection was associated with a significantly higher favorable prognosis (3-year OS; 20.4% vs. 0%, p = 0.026). Moreover, the additional use of molecular targeted drugs significantly improved the survival. In multivariate analysis, the differentiated histologic type, R0/1 resection, and parallel use of molecular targeted drugs remained independent factors of a favorable outcome. Conclusions: The present study suggested that aggressive curative resection with perioperative chemotherapy might improve survival and that primary tumor resection might improve the outcome in the non-R0/1 group.

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“…То есть авторы предложили диффе-ренцированный подход к отбору пациентов для удале-ния первичной опухоли. Однако риск субъективного отбора больных в данном анализе остается высоким, и результаты могли быть случайными [24].…”

Section: действие химиотерапии на первичную опухольunclassified

Does asymptomatic primary tumor need to be removed in unresectable metastatic colon cancer?

Федянин¹,

Трякин²,

Тюляндин³

2015

Onkol. koloproktol.

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Is primary tumour resection associated with survival improvement in patients with colorectal cancer and unresectable synchronous metastases? A pooled analysis of individual data from four randomised trials

Cited by 121 publications

References 42 publications

Primary Tumour Resection Could Improve the Survival of Unresectable Metastatic Colorectal Cancer Patients Receiving Bevacizumab-Containing Chemotherapy

Primary Tumour Resection Could Improve the Survival of Unresectable Metastatic Colorectal Cancer Patients Receiving Bevacizumab-Containing Chemotherapy

Outcomes of stage IV patients with colorectal cancer treated in a single institution: What is the key to the long-term survival?

Does asymptomatic primary tumor need to be removed in unresectable metastatic colon cancer?

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