Primary tumor resection in metastatic colorectal cancer (mCRC): A prospective cohort study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3584-3584
Author(s):  
Shu Fen Wong ◽  
Kathryn M Field ◽  
Suzanne Kosmider ◽  
Jeanne Tie ◽  
Hui-li Wong ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Cox Regression ◽  
Tumor Resection ◽  
Tumor Burden ◽  
Primary Tumor Resection ◽  
Significant Survival ◽  
The Impact ◽  
Modern Era ◽  
Systemic Therapies

3584 Background: The role of primary tumor resection in patients presenting with mCRC remains controversial. Previously reported survival benefits associated with primary tumor resection may not translate in the modern era of systemic therapies. We examined the impact of primary tumor resection on survival in a modern cohort of mCRC patients. Methods: Patients were identified using a clinician-designed mCRC registry involving 15 participating Australian sites from mid 2009. Patients were excluded if planned for curative metastasectomy or had incomplete data. Univariate logistic regression and multivariate cox regression was utilized to identify significant associations between resection, clinical variables and survival outcomes. Results: We identified 682 mCRC patients with median follow up 20 months. 40% (n = 275) had their primary in-situ. Rates of primary resection were higher for age > 70 years (OR 1.66 95% CI [1.22 – 2.26], p = 0.001) and Charlson score ≥3 (OR 1.50 [1.10 – 2.06], p = 0.011). Lower resection rates were observed for rectal v colon primary (OR 0.39 [0.28 – 0.55], p < 0.001), liver metastases (OR 0.59 [0.42 – 0.82], p = 0.002) and ECOG 2 - 4 (OR 0.64 [0.45 – 0.92], p = 0.015). There was a significant survival advantage for pts with primary tumor resection (median OS 21.3 vs 16.8 months; HR 0.63, p < 0.001), even when adjusting for known prognostic factors in a multivariate analysis (HR 0.56 [0.44 – 0.72], p < 0.001). Multivariate analyses also demonstrated that age > 70 years (HR 1.32 [1.03 – 1.71], p = 0.031) and ECOG ≥ 2 (HR 3.17 [2.43 – 4.15], p < 0.001) were significantly associated with poorer outcomes; whereas chemotherapy use (HR 0.61 [0.45 – 0.84], p = 0.002), bevacizumab use (HR 0.68 [0.52 – 0.89], p = 0.005) and rectal primary (HR 0.69 [0.53 – 0.91], p = 0.009) predicted improved survival. Conclusions: Our study suggests that primary tumor resection is associated with significant survival advantages for mCRC patients in the modern era of systemic therapies. The 40% of primary cancers in-situ is higher than previous mCRC studies and suggests a tendency for non-operative intervention in Australia. Further analysis aimed at examining the impact of other confounding variables such as tumor burden is ongoing and will be presented.

scholarly journals The Impact of Primary Tumor Resection on Survival in Asymptomatic Colorectal Cancer Patients With Unresectable Metastases

2021 ◽  
Vol 37 (2) ◽  
pp. 94-100
Author(s):  
Ki Yoon Doah ◽  
Ui Sup Shin ◽  
Byong Ho Jeon ◽  
Sang Sik Cho ◽  
Sun Mi Moon
Keyword(s):  
Colorectal Cancer ◽  
Primary Tumor ◽  
Cox Regression ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Multivariate Logistic Regression Model ◽  
Risk Of Cancer ◽  
The Impact ◽  
Unresectable Metastases

Purpose: This study was conducted to evaluate the effectiveness of primary tumor resection (PTR) in asymptomatic colorectal cancer (CRC) patients with unresectable metastases using the inverse probability of treatment weighting (IPTW) method to minimize selection bias.Methods: We selected 146 patients diagnosed with stage IV CRC with unresectable metastasis between 2001 and 2018 from our institutional database. In a multivariate logistic regression model using the patients’ baseline covariates associated with PTR, we applied the IPTW method based on a propensity score and performed a weighted Cox proportional regression analysis to estimate survival according to PTR.Results: Upfront PTR was performed in 98 patients, and no significant differences in baseline factors were detected. The upweighted median survival of the PTR group was 18 months and that of the non-PTR group was 15 months (P = 0.15). After applying the IPTW, the PTR was still insignificant in the univariate Cox regression (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.5–1.21). However, in the multivariate weighted Cox regression with adjustment for other covariates, the PTR showed a significantly decreased risk of cancer-related death (HR, 0.61; 95% CI, 0.40–0.94).Conclusion: In this study, we showed that asymptomatic CRC patients with unresectable metastases could gain a survival benefit from upfront PTR by analysis with the IPTW method. However, randomized controlled trials are mandatory.

scholarly journals Subdivision of metastatic colorectal cancer for identifying patients who benefit more from primary tumor resection

2021 ◽  
Author(s):  
Dakui Luo ◽  
Zezhi Shan ◽  
Zhiqiang Li ◽  
Simin Chen ◽  
Sanjun Cai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Primary Tumor ◽  
Cox Regression ◽  
Tumor Resection ◽  
Signet Ring Cell ◽  
Normal Serum ◽  
Primary Tumor Resection ◽  
Cox Regression Analysis ◽  
Serum Cea

Abstract Background Stage IV colorectal cancer (CRC) patients are heterogeneous with distinctive clinicopathologic features and prognosis. Radical resection of primary tumor and distant metastases is associated with improved survival outcomes in metastatic CRC. The value of palliative primary tumor resection is controversial. The present study explored which subgroups benefited more from primary tumor resection in metastatic CRC. Methods Between 2004 and 2015, patients with metastatic CRC were identified using the surveillance, epidemiology, and end results (SEER) database. Uni- and multivariable Cox regression analysis were performed to identify factors associated with decreased cancer-specific mortality. The subgroups were divided based on the independent prognostic factors. Results Age, marital status, race, serum CEA, histologic type, differentiation, tumor location, surgery of primary or metastatic lesion, site of metastases, number of metastatic sites, chemotherapy and radiotherapy were identified as independent prognostic factors. Patients with non-white race, normal serum CEA, non-signet ring cell carcinoma, well or moderate differentiation, surgery of metastases, isolated liver metastasis, single metastasis, receiving chemotherapy or radiotherapy presented more survival benefit from primary tumor resection. Conclusion Subgroup of metastatic CRC optimizes decision-making and selected patients will benefit more from primary tumor resection.

Role of Up-Front Primary Tumor Resection and Tumor Sidedness in the Survival of Synchronous Metastatic Colon Cancer Patients

2021 ◽  
pp. 1-7
Author(s):  
Dave E.W. van der Kruijssen ◽  
Karlijn L. van Rooijen ◽  
Sophie A. Kurk ◽  
Johannes H.W. de Wilt ◽  
Cornelis J.A. Punt ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Confidence Interval ◽  
Primary Tumor ◽  
Cox Regression ◽  
Performance Status ◽  
Tumor Resection ◽  
Serum Lactate ◽  
Primary Tumor Resection ◽  
Serum Lactate Dehydrogenase ◽  
Metastatic Colon Cancer

<b><i>Introduction:</i></b> Uncertainty exists about a possible survival benefit of primary tumor resection (PTR) in synchronous metastatic colon cancer (mCC). Since sidedness of the primary tumor is regarded as an important prognostic factor, our objective was to study the interaction between PTR and sidedness in synchronous mCC. <b><i>Methods:</i></b> In this retrospective study, we used data from 2 first-line phase 3 randomized controlled trials (RCTs). A mixed Cox regression model was used to study the multiplicative interaction between PTR and sidedness. We adjusted for age, treatment arm, WHO performance status, number of affected organs by metastases, serum lactate dehydrogenase, and year of enrollment. <b><i>Results:</i></b> We found that PTR is associated with better survival in both right-sided (hazard ratio [HR] 0.59 [95% confidence interval 0.42–0.8 2]) and left-sided mCC (HR 0.70 [95% confidence interval 0.52–0.93]). The interaction between PTR and sidedness was not significant (<i>p</i> = 0.45). <b><i>Conclusion:</i></b> Our data suggest that the prognostic value of PTR is independent of sidedness. Validation of these results will be performed in ongoing RCTs.

scholarly journals Subdivision of metastatic colorectal cancer for identifying patients who benefit more from primary tumor resection

2020 ◽  
Author(s):  
Dakui Luo ◽  
Zezhi Shan ◽  
Qi Liu ◽  
Sanjun Cai ◽  
Qingguo Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Primary Tumor ◽  
Cox Regression ◽  
Tumor Resection ◽  
Signet Ring Cell ◽  
Normal Serum ◽  
Primary Tumor Resection ◽  
Cox Regression Analysis ◽  
Serum Cea

Abstract Background Stage IV colorectal cancer (CRC) patients are heterogeneous with distinctive clinicopathologic features and prognosis. Radical resection of primary tumor and distant metastases is associated with improved survival outcomes in metastatic CRC. The value of palliative primary tumor resection is controversial. The present study explored which subgroups benefited more from primary tumor resection in metastatic CRC. Methods Between 2004 and 2015, patients with metastatic CRC were identified using the surveillance, epidemiology, and end results (SEER) database. Uni- and multivariable Cox regression analysis were performed to identify factors associated with decreased cancer-specific mortality. The subgroups were divided based on the independent prognostic factors. Results Age, marital status, race, serum CEA, histologic type, differentiation, tumor location, surgery of primary or metastatic lesion, site of metastases, number of metastatic sites, chemotherapy and radiotherapy were identified as independent prognostic factors. Patients with non-white race, normal serum CEA, non-signet ring cell carcinoma, well or moderate differentiation, surgery of metastases, isolated liver metastasis, single metastasis, receiving chemotherapy or radiotherapy presented more survival benefit from primary tumor resection. Conclusion Subgroup of metastatic CRC optimizes decision-making and selected patients will benefit more from primary tumor resection.

Prognostic importance of primary tumor resection and synchronous metastasis on overall survival in metastatic colorectal cancer: Data from the FIRE-3 (AIO KRK-0306) study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4070-4070
Author(s):  
Jobst C. von Einem ◽  
Sebastian Stintzing ◽  
Ludwig Fischer von Weikersthal ◽  
Thomas Decker ◽  
Alexander Kiani ◽  
...  
Keyword(s):  
Overall Survival ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Primary Tumor Resection ◽  
P Value ◽  
Line Treatment ◽  
First Line ◽  
Significant Difference ◽  
The Impact ◽  
First Line Treatment

4070 Background: The FIRE-3 study (AIO KRK-0306) was designed as a randomized multicenter trial to compare the efficacy of FOLFIRI plus cetuximab (cet) to FOLFIRI plus bevacizumab (bev) as first-line treatment in KRAS WT mCRC patients. FOLFIRI plus cet as first-line treatment of KRAS WT mCRC patients resulted in comparable overall response rates (ORR) and progression free survival (PFS) when compared to FOLFIRI plus bev. Overall survival (OS) was significantly longer in the FOLFIRI plus cet arm. Methods: In the present analysis of the FIRE-3 trial we explored the impact of primary tumor resection on outcome in relation to anti-EGFR vs. anti-VEGF treatment. Furthermore, we investigated the prognostic value of synchronous versus metachronous metastases. Results: In patients with synchronous disease no significant difference in OS was detected when comparing resected (n=339) vs. non-resected (n=97) patients (p-value: 0.29, HR: 1.17, 95%-CI: 0.88 – 1.55). In the cetuximab arm, resection (n=167) showed no significant benefit in OS when compared to non-resection (n=52) (p-value: 0.51, HR: 1.15, 95%-CI: 0.77 – 1.71). Treated with bevacizumab, similar results were present, when comparing resection (n=172) vs. non-resection (n=45); (p-value: 0.29, HR: 1.25, 95%-CI: 0.83 – 1.9). A strong trend was seen when comparing OS in treatment arms cet. (n=219) vs. bev. (n=217)) for patients with synchronous disease; (p-value: 0.05, HR: 1,26, 95%-CI: 1.0 - 1.59). 436/592 pts suffered from synchronous, 153/592 from metachronous disease (in 3/592 pts the information was not given). Median OS in pts with synchronous disease was 24.5 months and 29.5 in pts with metachronous disease (p-value: 0.02, HR: 0.76, 95%-CI: 0.6 - 0.96). In pts treated in the cetuximab arm metachronous disease (n=77) was associated with a trend towards longer OS when compared to synchronous disease (n= 219) (p-value: 0.13, HR: 0.76, 95%-CI: 0.54 – 1.1). The same effect was present in the bevacizumab arm (p-value: 0.05, HR: 0.73, 95%-CI 0.53 – 1.0) when comparing pts with synchronous disease (n=217) vs. pts. with metachronous disease (n=76). Conclusions: In the FIRE-3 study, metachronous disease was associated with superior OS compared to synchronous disease. This finding was accentuated in the bevacizumab arm. The role of resection of the primary tumor had no impact on survival. Clinical trial information: NCT00433927 .

Metastatic colorectal cancer (mCRC) with primary in situ: An Australian registry.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 498-498
Author(s):  
Shu Fen Wong ◽  
Kathryn M Field ◽  
Suzanne Kosmider ◽  
Jeanne Tie ◽  
Hui-Li Wong ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Primary Tumor ◽  
De Novo ◽  
Performance Status ◽  
Tumor Resection ◽  
Operative Intervention ◽  
Primary Tumor Resection ◽  
Survival Outcomes ◽  
Poor Performance Status

498 Background: The role of primary tumor resection in patients presenting with mCRC remains controversial. While recent data suggest resection of the primary tumor is unnecessary with modern systemic therapies, other series indicate that non-operative intervention may be associated with inferior survival outcomes. We aimed to evaluate the Australian approach to primary tumor resection in patients with mCRC and to explore its impact on survival outcomes. Methods: This study was conducted using a clinician-designed mCRC registry involving 15 participating Australian sites. Patients were excluded if planned for curative resection of metastatic disease or had incomplete data. Cox logistic regression analyses were used to identify and quantify associations between overall survival (OS) and patient/clinical variables. Results: We identified 533 mCRC patients with median follow up 12.5 mo. 41% (n=220) had their primary in-situ. Rates of primary tumor resection were higher in older patients (>70 yrs old) (64.5% vs 52.7%; p=0.006), colon versus rectal primaries (64.6% vs 42.7%; p<0.001) and those without liver metastases (70.7% vs 52.9%; p<0.001). Median OS was significantly better in patients undergoing primary tumor resection compared to the non-resected population (28.3 mo vs 15.9 mo; Hazard Ratio (HR): 0.52; log-rank p<0.001). Univariate analyses indicate that older age (HR: 1.69; p<0.001), poor performance status (HR: 4.44; p<0.001) and peritoneal involvement (HR: 1.94; p<0.001) were associated with poorer survival outcomes while chemotherapy administration (HR: 0.33; p<0.001) predicted improved survival. Multivariate analyses, when adjusted for known prognostic factors, confirms that primary tumor resection remains an independent predictor of better survival (HR: 0.50; p<0.001). Conclusions: The 41% of primary cancers in-situ is higher than previous mCRC studies and suggests a tendency for non-operative intervention in Australia. Given the survival outcomes demonstrated in this study, a review of Australian clinical practice is required. Future studies will examine the survival differences in patients with de novo versus relapsed metastatic disease, motivation for resection and other confounding variables.

scholarly journals The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer

2010 ◽  
Vol 13 (1) ◽  
pp. 90 ◽  
Author(s):  
Soo Kyung Ahn ◽  
Wonshik Han ◽  
Hyeong-Gon Moon ◽  
Jong-Han Yu ◽  
Eunyoung Ko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Stage Iv Breast Cancer ◽  
The Impact

scholarly journals Primary Tumor Resection for Rectal Cancer With Unresectable Liver Metastases: A Chance to Cut Is a Chance for Improved Survival

2021 ◽  
Vol 11 ◽  
Author(s):  
Jia-nan Chen ◽  
Sami Shoucair ◽  
Zheng Wang ◽  
Joseph R. Habib ◽  
Fu-qiang Zhao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Liver Metastases ◽  
Primary Tumor ◽  
Regression Models ◽  
Cox Regression ◽  
Tumor Resection ◽  
Primary Tumor Resection ◽  
Term Survival ◽  
Resection Group ◽  
Unresectable Liver Metastases

Background: About half of the patients with rectal cancer will develop liver metastasis during the course of their illness. Unfortunately, a large proportion of these metastases are unresectable. Surgical resection of the primary tumor vs. palliative treatment in patients with unresectable synchronous liver metastases remains controversial.Methods: Patients with rectal cancer with surgically unresectable liver metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010, to December 31, 2015. According to different treatment modalities, patients were divided into a primary tumor resection group and a non-resection group. Rates of primary tumor resection and survival were calculated for each year. Kaplan–Meier methods and Cox regression models were used to assess long-term survival. Multivariable logistic regression models were used to evaluate factors potentially associated with primary tumor resection.Results: Among 1,957 patients, 494 (25.2%) had undergone primary tumor resection. Patients with primary tumor resection had significantly better 5-year survival rate (27.2 vs. 5.6%, P &lt; 0.001) compared to the non-resection group. Chemoradiotherapy with primary site resection was associated with the longest mean and 5-year OS (44.7 months, 32.4%). The Cox regression analyses of the subgroup indicated that patients who underwent primary tumor resection had improved survival compared with those who did not undergo resection in all 25 subgroups. Factors associated with primary tumor resection were well or moderately differentiated tumor grade, undergoing radiation, and primary tumor size &lt;5 cm.Conclusions: The majority of patients with rectal cancer with unresectable liver metastases did not undergo primary tumor resection. Our results indicate that resection of the primary tumor appears to offer the greatest chance of survival. Prospective studies are needed to confirm these results.

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