Role of Primary Tumor Resection Among Chemotherapy-Treated Patients with Synchronous Stage IV Colorectal Cancer: A Survival Analysis

Abstract

Introduction The benefit of an operation to remove the primary tumor among patients with synchronous stage IV colorectal cancer is controversial. This study analyzed the survival benefits associated with primary tumor resection among chemotherapy-treated stage IV colorectal cancer patients. Methods The study analyzed 11,716 chemotherapy-treated stage IV colorectal cancer patients in the California Cancer Registry between 1996 and 2007, with follow-up through 2009. Patients were stratified into operation and non-operation groups. Estimates of median overall and colorectal cancer-specific survival were generated. Results Patients undergoing operation compared to those who are not had higher median overall and colorectal cancer-specific survival, 21 versus 10 months (p <0.0001) and 22 versus 12 months (p <0.0001), respectively. Patients who were offered surgery but refused had decreased median overall and colorectal cancer-specific survival when compared to patients who underwent resection, 8 versus 21 months (p <0.001) and 7 versus 22 months (p <0.001), respectively. In multivariate regression models, patients who underwent resection of primary tumor had improved overall (hazard ratio (HR), 0.42; 95 % confidence interval (CI) 0.40–0.44, p <0.0001) and colorectal cancer-specific survival (HR, 0.43; 95 % CI, 0.41–0.45; p <0.0001). Conclusion Primary tumor resection is associated with improved survival among stage IV chemotherapy-treated colorectal cancer patients.

Clinical Study on the Medical Value of Combination Therapy Involving Adoptive Immunotherapy and Chemotherapy for Stage IV Colorectal Cancer (COMVI Study)

“…Although the patients with DCBM affected the results, good outcomes were obtained even with consideration of the influence. Furthermore, synchronous metastases have been reported to confer a poor prognosis (28)(29)(30), and five out of the six patients in this study had synchronous metastases. The results might have been biased because of the small number of patients in this clinical trial.…”

Surgical Resection of Primary Tumor in Asymptomatic or Minimally Symptomatic Patients With Stage IV Colorectal Cancer: A Canadian Province Experience

“…Several studies that used registry data have demonstrated survival benefit of resection of the primary tumor in stage IV CRC. 2,4,6,7 However, most studies failed to adjust for performance status and other important clinicopathological variables. In agreement with the other reports, our data revealed that patients who underwent surgery were younger with less disease burden compared with the nonsurgical group, which suggests a selection bias for the surgical intervention.…”

Primary tumor resection in stage IV unresectable colorectal cancer: what has changed?

“…Median overall survival in these groups was 18.3 and 8.4 months, respectively [ 36 ]. The analysis of 11,716 chemotherapy-treated stage IV colorectal cancer patients in California Cancer Registry was performed and published in 2014 by Tsang et al Study showed that surgery was linked to higher median overall and colorectal cancer-specific survival (21 vs. 10 months and 22 vs. 12 months, respectively—in surgery vs. no surgery groups) [ 37 ].…”