Palliative resection of the primary tumor is associated with improved overall survival in incurable stage IV colorectal cancer: A nationwide population‐based propensity‐score adjusted study in the Netherlands

Abstract

As the value of palliative primary tumor resection in stage IV colorectal cancer (CRC) is still under debate, the purpose of this population-based study was to investigate if palliative primary tumor resection as the initial treatment after diagnosis was associated with improved overall survival. All patients with stage IV colorectal adenocarcinoma (2008-2011) were selected from the Netherlands Cancer Registry, and patients undergoing treatment with curative intent (i.e., metastasectomy, radiofrequency ablation and/or hyperthermic intraperitoneal chemotherapy), or best supportive care were excluded. After propensity score matching, a multivariable Cox proportional hazard model was performed to determine the association between treatment strategy and mortality. From a total group of 10,371 patients with stage IV CRC, 2,746 patients (26%) underwent an elective palliative resection of the primary tumor, whether or not followed by systemic therapy, and 3,345 patients (32%) were initially treated with palliative systemic therapy. After propensity score matching, median overall survival in these groups was 17.2 months (95% CI 16.3-18.1) and 11.5 months (95% CI 11.0-12.0), respectively. In Cox regression analysis, primary tumor resection was significantly associated with improved overall survival (hazard ratio of death = 0.44 [95% CI 0.35-0.55], p < 0.001). This large population-based study shows an overall survival benefit for patients with incurable stage IV CRC who underwent primary tumor resection as the initial treatment after diagnosis, compared to patients who started systemic therapy with the primary tumor in situ. This result is an argument in favor of resection of the primary tumor, even when patients have little to no symptoms.

High Serum CA19-9 Concentration Predicts Poor Prognosis in Elderly Patients with Stage IV Colorectal Cancer

“…In general, curative resection and chemotherapy might be the optimal treatment strategy for middle-aged patients with stage IV CRC [9]. Some studies reported that resection of only the primary tumor improved OS or relapse-free survival in stage IV CRC [23-25]. In this study, the OS of the 66 patients (80.5%) who underwent resection of the primary tumor was significantly longer than that of the patients who did not undergo primary tumor resection.…”

Comparative performance of a modified landmark approach when no time of treatment data are available within oncological databases: exemplary cohort study among resected pancreatic cancer patients

“…So far, published studies on that topic have rather focused on the conventional landmark approach which, however, requires time of treatment information 6,27–30. Given that this information is often not available and the modified version of the landmark approach is usually intuitively used,31 exploring the performance of the derived results relative to the Mantel–Byar method is of high relevance.…”

Short- and long-term outcomes following laparoscopic palliative resection for patients with incurable, asymptomatic stage IV colorectal cancer: A multicenter study in Japan

“…Whether it is best to resect the primary growth first and then perform systemic chemotherapy for stage IV colorectal cancer patients remains unclear. However, palliative resection of the primary growth is performed in most of these patients, on the basis of several reports that have shown improvement in the long-term effects of palliative bowel resection [3][4][5] . Despite the lack of reliable evidence demonstrating the benefit for laparoscopic primary resection for patients with stage IV colorectal cancer, the number of laparoscopic resections has been rising in recent years.…”

“…for patients with incurable, asymptomatic stage IV colorectal cancer: A multicenter study in Japan Tomonori Akagi 1) , Masafumi Inomata 1) , Suguru Hasegawa 2) , Yousuke Kinjo 2) , Masaaki Ito 3) , Yosuke Fukunaga 4) , Akiyoshi Kanazawa 5) , Hitoshi Idani 6) , Seiichiro Yamamoto 7) , Koki Otsuka 8) , Shungo Endo 9)…”

“…most of these patients with incurable synchronous metastases undergo palliative resection of the primary growth, because several reports demonstrated improved long-term effects of palliative primary resection for this disease [2][3][4][5] . We previously reported the usefulness of palliative primary resection of symptomatic, incurable stage IV colorectal cancer by laparoscopic surgery (LS) compared with open surgery (OS) 6) .…”