Worth it or not? Primary tumor resection for stage IV pancreatic cancer patients: A SEER‐based analysis of 15,836 cases

Fu, Ningzhen; Yu, Jiang; Weng, Yiwu; Hao, Chunyan; Deng, Xiaxing; Shen, Baiyong

doi:10.1002/cam4.4147

Cited by 8 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These ndings potentially explain the limited e cacy of PTR, chemotherapy, and radiotherapy in patients with brain metastases. Similar results will be shown, Ningzhen Fu [17] concluded that patients with brain metastases from pancreatic cancer cannot obtain survival bene ts from PTR, shuncang Zhu [21] believed that PTR could not improve the survival time of patients with lung adenocarcinoma if brain metastasis occurred. However, the use of chemotherapy has shown a certain effect in improving the survival of patients with brain metastases [22] , for example.…”

Section: Discussionsupporting

confidence: 67%

“…This underscores the consistent survival bene ts of stage IV BC patients at different time points following surgical intervention. Jianlong Jia [16] and Ningzhen Fu [17] also utilized sequential landmark analyses to account for time-related biases in their discussions of stage 4 non-small cell carcinoma and pancreatic cancer, ultimately concluding that surgery exhibited distinct advantages.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Value of Primary Tumor Resection among Different Treatment Methods in Stage IV Breast Cancer: Robust Evidence for Prognostic Benefit

Pan,

Chen,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Primary tumor resection (PTR) in stage IV breast cancer (BC) patients currently lacks robust evidence supporting a prognostic benefit, and the guidelines do not actively endorse this practice. The circumstances under which patients may benefit from this procedure remain uncertain. Methods: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program in the United States offers treatment data for stage IV breast cancer patients. We conducted a screening of patients diagnosed with metastatic breast cancer between 2010 and 2015. The primary outcomes focused on were overall survival (OS) and cancer-specific survival (CSS). We employed Kaplan-Meier method, Cox proportional hazard regression models, propensity score matching (PSM) to balance key confounding variables, and sequential landmark analyses to mitigate the impact of time-related factors on the results. Results: This study included 11,359 patients with stage IV breast cancer (BC). Patients who received primary tumor resection (PTR) experienced improved overall survival (OS) and cancer-specific survival (CSS). For OS (median survival time), the comparisons were as follows: chemoradiotherapy plus PTR versus chemoradiotherapy, with survival times of 56 months versus 25 months (p < 0.001); radiotherapy plus PTR versus radiotherapy, with survival times of 51 months versus 27 months (p < 0.001); chemotherapy plus PTR versus chemotherapy, with survival times of 45 months versus 32 months (p < 0.001); and only PTR versus no treatment, with survival times of 35 months versus 22 months (p < 0.001). Multivariate adjustment analysis, propensity score matching (PSM), and sequential landmark analyses provided further validation of these results. When stratified by different metastasis patterns, PTR significantly improved OS and CSS in patients with metastases in other organs, excluding brain metastasis. Regarding OS, the adjust hazard ratios (aHR) for different metastasis sites were as follows: bone metastasis (aHR0.555, 95% CI 0.514-0.598, p < 0.001); liver metastasis (aHR0.703, 95% CI 0.593-0.835, p < 0.001); brain metastasis (aHR0.639, 95% CI 0.549-0.734, p < 0.001); bone-liver metastasis (aHR0.716, 95% CI 0.601-0.852, p < 0.001); bone-lung metastasis (aHR0.782, 95% CI 0.667-0.915, p = 0.002); bone, liver, and lung metastasis (aHR0.712, 95% CI 0.550-0.921, p = 0.010). Notably, many patients with brain metastasis did not derive significant benefits from chemotherapy, and patients with liver metastasis saw improvements with radiotherapy alone. Similar conclusions were observed for cancer-specific survival (CSS). Conclusion: In patients with stage IV breast cancer, PTR in combination with chemotherapy or chemoradiotherapy can improve survival time. However, in cases of solitary brain metastasis and multiple metastases including brain metastasis, the decision to use PTR should be made with caution.

show abstract

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

The Value of Primary Tumor Resection among Different Treatment Methods in Stage IV Breast Cancer: Robust Evidence for Prognostic Benefit

Pan,

Chen,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…However, this study observed that radiotherapy is no longer a risk factor for prognosis through multivariate analysis. Adjuvant chemotherapy can considerably enhance the survival of PC patients [20] . This study also proves that chemotherapy is an in uential protective factor for metastatic PC.…”

Section: Discussionmentioning

confidence: 99%

A nomogram predicting overall survival for metastatic pancreatic cancer: SEER database analysis

Liu

Chen

Zhang

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: This study's motive was to find out the determinants of average survival for sufferers with metastatic pancreatic cancer (PC) and formulate a nomogram to evaluate overall survival (OS).Methods: A whole of 10165 sufferers with metastatic PC identified from 2010 to 2015 were recruited from the Surveillance, Epidemiology, and End Results (SEER) application. All sufferers were randomly assigned to a training set (n=7117) and an internal validation set (n=3048). A nomogram was built derived from univariate and multivariate Cox evaluation to evaluate an individual patient's 6-, 12- and 18-month OS. The nomogram's overall performance used to be assessed via concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration plots.Results: A whole of 10165 sufferers with metastatic PC identified from 2010 to 2015 had been included. Our analysis revealed that age, race, grade, N stage, bone metastasis, brain metastasis, liver metastasis, lung metastasis, surgery, and chemotherapy were identified as independent predictors for overall survival. The C-index of training set was 0.681 (95%CI:0.673-0.689) and validation set was 0.689 (95%CI:0.677-0.701). The calibration curves validated that the nomogram estimated 6-, 12- and 18-month OS precisely. Kaplan-Meier curves confirmed sizable variation in OS amongst the stratified low-, and high-risk groups (P<0.0001).Conclusions: The nomogram efficiently forecasts OS in sufferers with metastatic PC. This predictive model may assist clinicians in risk stratification, prognosis predictions, and facilitating personalized treatment.

show abstract

“…The largest observational evidence on this topic comes from a SEER-based analysis published in 2021 [104]. The 15,836 stage IV patients diagnosed between 1976 and 2016 were compared as follows: chemotherapy with or without primary tumor resection (9515), chemoradiation with or without primary tumor resection (699) and no treatment versus primary tumor resection only (5403).…”

Section: Overview Of Available Literature Datamentioning

confidence: 99%

Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice

Fanotto

Salani

Vivaldi

et al. 2023

Cancers

View full text Add to dashboard Cite

The management of the primary tumor in metastatic colorectal, gastric and pancreatic cancer patients may be challenging. Indeed, primary tumor progression could be associated with severe symptoms, compromising the quality of life and the feasibility of effective systemic therapy, and might result in life-threatening complications. While retrospective series have suggested that surgery on the primary tumor may confer a survival advantage even in asymptomatic patients, randomized trials seem not to definitively support this hypothesis. We discuss the evidence for and against primary tumor resection for patients with metastatic gastrointestinal (colorectal, gastric and pancreatic) cancers treated with systemic therapies and put in context the pros and cons of the onco-surgical approach in the time of precision oncology. We also evaluate current ongoing trials on this topic, anticipating how these will influence both research and everyday practice.

show abstract

Worth it or not? Primary tumor resection for stage IV pancreatic cancer patients: A SEER‐based analysis of 15,836 cases

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 8 publications

References 28 publications

The Value of Primary Tumor Resection among Different Treatment Methods in Stage IV Breast Cancer: Robust Evidence for Prognostic Benefit

The Value of Primary Tumor Resection among Different Treatment Methods in Stage IV Breast Cancer: Robust Evidence for Prognostic Benefit

A nomogram predicting overall survival for metastatic pancreatic cancer: SEER database analysis

Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice

Contact Info

Product

Resources

About