Not all rectal cancer patients could benefit from the surgery on the primary site

Abstract

Purpose Pieces of evidence showed the surgery on the primary site could improve the prognosis of rectal cancer patients, but the results were inconsistent. The present study investigates whether all patients could benefit from the surgery. Methods The rectal cancer patients diagnosed between 2010 and 2019 in the Surveillance, Epidemiology, and End Results cohort were included. Multivariable Cox regression was utilized to investigate the effect of the primary site surgery on the prognosis in total patients and stratified by the age, M stage and the number of distant metastatic organs. The propensity score matching (PSM) method was also used to balance observed covariates and Kaplan-Meier method with the log-rank test was used to exam the differences in the prognosis. Results A total of 76,941 rectal cancer patients were included and about 68.1% received surgery. The patients with surgery have a relatively lower proportion of advanced age, higher differentiated grade, T stage, N stage, M stage, and bone, brain, lung, and liver metastasis than patients without surgery. Multivariable Cox regression showed a protective effect of the surgery on the prognosis, even in patients with advanced age, distant metastasis, and multiple organ metastasis. However, no association was found in patients with four organ metastases. The PSM also confirmed the results mentioned above. Conclusion Not all rectal cancer patients could benefit from the surgery, especially the patients with four organ distant metastases. The results could help the clinicians to tailor targeted treatment regimens and provide a guideline for making surgical decisions.