Palliative primary tumor resection provides survival benefits for the patients with metastatic colorectal cancer and low circulating levels of dehydrogenase and carcinoembryonic antigen

He, Weiling; Rong, Yuming; Jiang, Chang; Liao, Fangxin; Yin, Chenxi; Guo, Guifang; Qiu, Huijuan; Zhang, Bei; Xia, Ling

doi:10.1186/s40880-016-0120-4

Cited by 8 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Figure 1 shows the study flow diagram. Seventy‐seven comparative studies fulfilled the inclusion criteria of this meta‐analysis [2, 4–8, 10–27, 30–50, 69–100]. There were 159,991 patients for analysis, including 94,745 (59.2%) in the PTR group and 65,246 (40.8%) in the PTI group.…”

Section: Resultsmentioning

confidence: 99%

“…For patients with incurable colorectal cancer, an important question which remains unanswered to date is whether the best treatment strategy is primary tumor resection (PTR) with chemotherapy or immediate chemotherapy without PTR. Previous published comparative studies reported conflicting results on this issue, with some studies demonstrating improved survival with PTR compared to primary tumor intact (PTI) [2, 4–32], while other studies found no significant differences between the two groups [33–40], and other studies suggested systemic chemotherapy without resection of the primary tumor is the treatment strategy of choice for patients with incurable colorectal cancer [41–50]. The purpose of the present study was to perform a systematic review of the literature and employ meta‐analytical techniques to compare survival and adverse events in patients undergoing PTR versus PTI, with or without chemotherapy, in order to determine whether PTR should be performed in patients with incurable localized or metastatic colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta‐analysis

et al. 2019

View full text Add to dashboard Cite

Background To assess the impact of primary tumor resection (PTR) on survival and morbidity in incurable colorectal cancer. Methods Systematic literature review and meta-analysis to compare PTR versus primary tumor intact (PTI). Results Seventy-seven studies were included, reporting on 159,991 participants (94,745 PTR; 65,246 PTI). PTR improved overall survival (hazard ratio [HR] 0.59, P \ 0.0001; mean difference [MD] 7.27 months, P \ 0.0001), cancer-specific survival (HR 0.47, MD 10.80), and progression-free survival (HR 0.76, MD 1.67). Overall survival remained significantly improved during subgroup analysis of asymptomatic patients (HR 0.69, MD 3.86), elderly patients (HR 0.46, MD 7.71), patients diagnosed after 2000 (HR 0.62, MD 7.29), patients with colon (HR 0.58, MD 6.31) or rectal (HR 0.54, MD 6.88) primary tumor, patients undergoing resection of primary tumor versus nonresectional surgery (NRS) to treat primary tumor complications (HR 0.56, MD 8.72), and of studies with propensity score analysis (HR 0.65, MD 5.68). Overall survival per treatment strategy was: [PTI/chemotherapy] 14.30 months, [PTI/bevacizumab] 17.27 months, [PTR/chemotherapy] 21.52 months, [PTR/bevacizumab] 27.52 months. PTR resulted in 4.5% perioperative mortality and 22.4% morbidity (major adverse events 10.2%, minor 18.5%, reoperation 2.5%, intraabdominal collection/sepsis 2.2%). PTI had 21.7% morbidity (obstruction 14.4%, anemia 11.0%, hemorrhage 1.5%, perforation 0.6%, adverse events requiring surgery 15.8%). NRS resulted in 10.6% perioperative mortality and 21.7% morbidity (major 7.9%, minor 21.7%, reoperation 0.1%). Conclusions PTR in patients with incurable colorectal cancer results in a limited improvement of survival without a significant increase in morbidity. PTR should be considered by the multidisciplinary team on an individual patient basis.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta‐analysis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…With the development of systemic chemotherapy and the treatment of local lesions, the benefit of palliative resection of the primary tumor in specific patient populations has been gradually recognized 19, 20. In our previous study, we found that patients with normal lactic dehydrogenase levels and a CEA level <70 ng/mL could benefit from palliative operation surgery without serious surgery-related complications 8.…”

Section: Discussionmentioning

confidence: 99%

“…Accumulating evidence indicates that certain populations can benefit from palliative resection 5-7. In our previous study, we found that palliative resection improved overall survival (OS) and progression-free survival (PFS) in certain patients 8.…”

Section: Introductionmentioning

confidence: 99%

Metastatic lymph node ratio as a prognostic indicator in patients with stage IV colon cancer undergoing resection

Jiang¹,

Wang²,

Guo³

et al. 2019

J. Cancer

Self Cite

View full text Add to dashboard Cite

Background : It has been shown that the metastatic lymph node ratio (LNR, metastatic LNs divided by the total number of retrieved LNs) significantly affects the prognosis of patients with non-stage IV and some curative stage IV colon cancer undergoing curative resection. In this study, we aimed to evaluate the role of the LNR as a predictor of prognosis in patients with stage IV colon cancer undergoing curative or palliative resection. Patients and Methods : We conducted a retrospective study of 424 patients who were initially diagnosed with stage IV colon cancer at the Sun Yat-Sen University Cancer Center from 2003 to 2014. The patients were divided into the curative and palliative primary tumor resection groups with regional lymph nodes harvest. The median value was used as the cutoff for the LNR. Overall survival (OS) was assessed with the Kaplan-Meier method and log-rank test. Multivariate analysis was performed to identify the prognostic factors for OS. Results : The cutoff value for the LNR was 0.2. A total of 71 and 353 patients were classified as being in the curative and palliative resection groups, respectively. Patients in the palliative resection group showed higher pretreatment levels of carbohydrate antigen 19-9 (CA199; P = 0.014), a deeper infiltration of the primary tumor ( P = 0.049), a lower regional lymph node harvest (i.e., total lymph node yield [TLN] ≤ 11; P = 0.001), and more extensive metastasis ( P = 0.006). Among all patients, initial elevated CA199 levels, a TLN≤11, a negative lymph nodes (NLN) ≤7, and a LNR ≤0.2 were significantly associated with an unfavorable prognosis. OS was significantly longer in patients with a low LNR in both groups ( P = 0.008 and P = 0.001, respectively). The LNR was an independent prognostic indicator in patients with stage IV colon cancer, with a hazard ratio (HR) of 1.47 (95% confidence interval [CI] 1.14-1.91; P = 0.003) in total population, and an HR of 1.43 (95% CI 1.09-1.86; P = 0.009) in patients with palliative resection. Conclusion : The LNR can be used as an independent prognostic factor in patients with stage IV colon cancer patients undergoing resection.

show abstract

“…48 Foi analisado um estudo de 2017, viabilidade de Infusão Arterial Hepática versus quimioterapia sistêmica, relacionando com o efeito protetor contra metástases hepáticas após ressecção curativa, em pacientes diagnosticados com câncer colorretal, que chegou a conclusão que A infusão intra-hepática não contribuiu para qualquer melhora acentuada na sobrevida global. 25 Por meio de uma análise multivariada, para pacientes com câncer colorretal metastático que possuem metástases irressecáveis, a ressecção paliativa do tumor primário pode melhorar a sobrevida geral e a progressão de sobrevida livre de progressão após a quimioterapia de primeira linha e ainda diminuir a incidência de envolvimento de novos órgãos, 28,29 dado questionado por Kim et al em seu estudo, no qual afirmou que as evidências na comparação entre a quimioterapia isolada e a quimioterapia associada à cirurgia permanecem obscuras. 49 O estudo sobre a relevância da localização do tumor primário em pacientes com câncer colorretal metastático, associada à redução inicial do tumor com o tratamento quimioterápico de primeira linha a base de FOLFIRI (irinotecano) + Panitumumabe apresentou que a redução precoce do tumor foi associada à melhora da sobrevida livre de progressão.…”

Section: Discussionunclassified

Estudo Comparativo Entre Protocolos De Ressecção E Tratamento Quimioterápico No Câncer Colorretal

Rodrigues¹,

Colobó²,

Silva³

et al. 2021

bjdv

View full text Add to dashboard Cite

Objetivo: Abordar o manejo do câncer colorretal, discutindo não só as indicações dos principais procedimentos terapêuticos do CCR, mas também quando combiná-las. Metodologia: Uma revisão integrativa desenvolvida a partir da seleção de ensaios clínicos publicados entre os anos de 2016 e 2021, disponíveis na base de dados do Pubmed. Os descritores utilizados foram: Cancer, colorectal OR Cancers, colorectal OR Carcinoma, colorectal OR Carcinomas, colorectal AND Chemotherapy AND Resection. Resultados: Ainda que alguns estudos demonstraram que a quimioterapia com FOLFIRIX foi favorável para a ressecção do câncer colorretal, outros atestam seu efeito negativo na ressecção de tumores locais e metástases. O uso de probióticos está associado a uma redução significativa das complicações da quimioterapia. A quimioterapia hipertérmica intraperitoneal adjuvante (HIPEC) associada a quimioterapia sistêmica demonstrou não superioridade em relação a apenas a quimioterapia. A infusão intra-hepática não contribuiu para a melhora da sobrevida global. A fluorescência foi observada em todos pacientes submetidos à técnica de cirurgia guiada. Conclusão: Ainda existem divergências com relação ao uso da terapia adjuvante, diferente da neoadjuvante que apresentou eficácia na maioria dos casos. Sugere-se a realização de novos estudos para sanar as divergências e observar a longo prazo os resultados, principalmente, das novas terapias.

show abstract

Palliative primary tumor resection provides survival benefits for the patients with metastatic colorectal cancer and low circulating levels of dehydrogenase and carcinoembryonic antigen

Cited by 8 publications

References 20 publications

Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta‐analysis

Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta‐analysis

Metastatic lymph node ratio as a prognostic indicator in patients with stage IV colon cancer undergoing resection

Estudo Comparativo Entre Protocolos De Ressecção E Tratamento Quimioterápico No Câncer Colorretal

Contact Info

Product

Resources

About