Benefit of Surgical Resection of the Primary Tumor in Patients Undergoing Chemotherapy for Stage IV Colorectal Cancer with Unresected Metastasis

Maroney, Sean; Paz, Carlos Chavez de; Reeves, Mark E.; Garberoglio, Carlos A.; Raskin, Elizabeth R.; Senthil, Maheswari; Namm, Jukes P.; Solomon, Naveenraj L.

doi:10.1007/s11605-017-3617-5

Cited by 25 publications

(15 citation statements)

References 26 publications

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“…CEA levels positive is associated with worse prognosis and the prognosis of patients with lymphatic metastasis might be worse than those without. Currently, there exists controversy regarding the long-term benefit of primary tumor resection in stage IV and many prior studies suggest there is no benefit to survival with primary tumor resection (15,16) , while others suggest a clinical benefit with surgical resection (17)(18)(19) . In our study, we found the patients could significantly be beneficial from primary tumor resection with remarkable improvement of CSS.…”

Section: Discussionmentioning

confidence: 99%

A prognostic index model to individually predict clinical outcomes for colorectal cancer with synchronous bone metastasis

Guan¹,

Ma²,

Quan³

et al. 2020

J. Cancer

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Background: The prognosis of synchronous bone metastasis (BM) in colorectal cancer (CRC) is poor and rarely concerned. A clinical tool to evaluate the prognosis and clinical outcomes for BM would be attractive in current clinical practice. Methods: A total of 342 CRC patients with synchronous BM were identified from Surveillance, Epidemiology, and End Results (SEER) database. The cancer specific survival (CSS) was estimated with the Kaplan-Meier method. Prognostic factors were identified from multivariate Cox model, and the final clinical nomogram was developed to predict the CSS. The concordance index (C-index) was used to assess the discriminative ability. Calibration curves were provided to internally validate the performance of the nomogram. Results: The nomogram finally consisted of 6 prognostic factors including age, tumor grade, AJCC N stage, carcinoembryonic antigen (CEA) levels, primary tumor resection and chemotherapy, which translated the effects of prognostic factors into certain scores to predict the 1-, 2-and 3-year CSS for the synchronous BM in CRC patients. The nomogram presented a good accuracy for predicting the CSS with the C-index of 0.742. The calibration of the nomogram predictions was also accurate. Conclusions: This nomogram was accurate enough to predict the CSS of CRC patients with synchronous BM using readily available clinicopathologic factors and could provide individualized clinical decisions for both physicians and patients.

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Section: Discussionmentioning

confidence: 99%

A prognostic index model to individually predict clinical outcomes for colorectal cancer with synchronous bone metastasis

Guan¹,

Ma²,

Quan³

et al. 2020

J. Cancer

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“…More clinical studies focus on the benefits of primary tumor resection alone. Although there are still controversies at present [13,14], most of the existing clinical studies show that the resection of the primary tumor alone can not only reduce the incidence of local complications [15], but also seem to benefit the survival of patients [7,16,17]. However, there are limited data regarding the effect of primary tumor radiotherapy in stage IV unresectable rectal or rectosigmoid cancer, and most of these studies are mainly observing the palliative effect [18][19][20][21].…”

Section: Resultsmentioning

confidence: 99%

With versus Without Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival

Wang

Jin

et al. 2020

Preprint

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Background: To evaluate the impact of primary tumor radiotherapy on survival in patients with unresectable metastatic rectal or rectosigmoid cancer. Methods: Form September 2008 to September 2017, 350 patients with unresectable metastatic rectal or rectosigmoid cancer were retrospectively reviewed in our center. All patients received at least 4 cycles of chemotherapy, and were divided into two groups according to with primary tumor radiotherapy or without. 163 patients received primary tumor radiotherapy, and the median radiation dose was 56.69Gy(50.4-60). Survival curves were estimated from the Kaplan–Meier procedure to roughly compare survival among two groups. Subsequently, 18-month survival was used as the outcome variable for this study. This study mainly evaluated the impact of primary tumor radiotherapy on survival of these patients through a series of multivariate Cox regression analyses after propensity score matching (PSM). Results: The median follow-up time was 21 months. All 350 patients received a median of 7 cycles of chemotherapy (range 4-12), 163 (46.67%) patients received primary tumor radiotherapy for local symptoms. The Kaplan–Meier survival curves showed a significant overall survival (OS) advantage for primary tumor radiotherapy group to without radiotherapy (20.07 vs 17.33 months; P=0.002). In this study, multivariate Cox regression analysis after adjusted covariates, multivariate Cox regression analysis after PSM, and inverse probability of treatment weighting (IPTW) analysis and propensity score (PS)-adjusted model analysis consistently showed that primary tumor radiotherapy could effectively reduce the risk of death for these patients at 18 months (HR: 0.62, 95% CI 0.40-0.98; HR:0.79, 95% CI:0.93-1.45; HR: 0.70, 95% CI 0.55-0.99 and HR: 0.74, 95% CI:0.59-0.94). Conclusion: Compared with patients with stage IV rectal or rectosigmoid cancer who did not receive primary tumor radiotherapy, received primary tumor radiotherapy reduced the risk of death in these patients. The radical doses（59.4Gy/ 33 fractions or 60Gy/ 30 fractions） of radiation for primary tumors might be considered for unresectable metastatic rectal or rectosigmoid cancer, not just for relieve symptoms. Keywords: Stage IV Rectal cancer, primary tumor radiotherapy, propensity score matching.

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“…More clinical studies focus on the benefits of primary tumor resection alone. Although there are still controversies at present [16,17], most of the existing clinical studies show that resection of the primary tumor alone can not only reduce the incidence of local complications [18] but also seems to be beneficial in terms of patient survival [11,19,20]. However, there are limited data regarding the effect of primary tumor radiotherapy in stage IV unresectable rectal or rectosigmoid cancer, and most of these studies mainly observed the palliative effect [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival.

Wang

Wang²,

Huang

et al. 2020

Preprint

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Background: To evaluate the impact of primary tumor radiotherapy on survival in patients with unresectable metastatic rectal or rectosigmoid cancer.Methods: From September 2008 to September 2017, 350 patients with unresectable metastatic rectal or rectosigmoid cancer were retrospectively reviewed in our center. All patients received at least 4 cycles of chemotherapy and were divided into two groups according to whether they received primary tumor radiotherapy. A total of 163 patients received primary tumor radiotherapy, and the median radiation dose was 56.69 Gy (50.4-60). Survival curves were estimated with the Kaplan–Meier method to roughly compare survival between the two groups. Subsequently, the 18-month survival rate was used as the outcome variable for this study. This study mainly evaluated the impact of primary tumor radiotherapy on the survival of these patients through a series of multivariate Cox regression analyses after propensity score matching (PSM).Results: The median follow-up time was 21 months. All 350 patients received a median of 7 cycles of chemotherapy (range 4-12), and 163 (46.67%) patients received primary tumor radiotherapy for local symptoms. The Kaplan–Meier survival curves showed that the primary tumor radiotherapy group had a significant overall survival (OS) advantage compared to the group without radiotherapy (20.07 vs 17.33 months; P=0.002). In this study, the multivariate Cox regression analysis after adjusting for covariates, multivariate Cox regression analysis after PSM, inverse probability of treatment weighting (IPTW) analysis and propensity score (PS)-adjusted model analysis consistently showed that primary tumor radiotherapy could effectively reduce the risk of death for these patients at 18 months (HR: 0.62, 95% CI 0.40-0.98; HR: 0.79, 95% CI: 0.93-1.45; HR: 0.70, 95% CI 0.55-0.99 and HR: 0.74, 95% CI: 0.59-0.94).Conclusion: Compared with patients with stage IV rectal or rectosigmoid cancer who did not receive primary tumor radiotherapy, those who received primary tumor radiotherapy had a lower risk of death. The prescription dose (59.4 Gy/33 fractions or 60 Gy/30 fractions) of radiation for primary tumors might be considered not only to relieve symptoms improve the survival of patients with inoperable metastatic rectal or rectosigmoid cancer.

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Benefit of Surgical Resection of the Primary Tumor in Patients Undergoing Chemotherapy for Stage IV Colorectal Cancer with Unresected Metastasis

Cited by 25 publications

References 26 publications

A prognostic index model to individually predict clinical outcomes for colorectal cancer with synchronous bone metastasis

A prognostic index model to individually predict clinical outcomes for colorectal cancer with synchronous bone metastasis

With versus Without Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival

The Effect of Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival.

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