Primary Tumor Resection in Colorectal Cancer With Synchronous Unresectable Metastasis: Time to End the Debate?

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.

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Role of Primary Tumor Resection Among Chemotherapy-Treated Patients with Synchronous Stage IV Colorectal Cancer: A Survival Analysis

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-013-2421-0 ◽

2013 ◽

Vol 18 (3) ◽

pp. 592-598 ◽

Cited By ~ 13

Author(s):

Walter Y Tsang ◽

Argyrios Ziogas ◽

Bruce S. Lin ◽

Tara E. Seery ◽

William Karnes ◽

...

Keyword(s):

Colorectal Cancer ◽

Survival Analysis ◽

Primary Tumor ◽

Tumor Resection ◽

Stage Iv ◽

Primary Tumor Resection ◽

Stage Iv Colorectal Cancer

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Individualized prediction of survival benefit from primary tumor resection for patients with unresectable metastatic colorectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-020-01972-y ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Yi Yang ◽

Yujie Lu ◽

Wen Jiang ◽

Jinzhou Zhu ◽

Su Yan

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Primary Tumor ◽

Survival Benefit ◽

Tumor Resection ◽

Primary Tumor Resection ◽

Prediction Of Survival ◽

Individualized Prediction ◽

Unresectable Metastatic Colorectal Cancer

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Primary Tumor Resection in Patients With Metastatic Colorectal Cancer Is Associated With Reversal of Systemic Inflammation and Improved Survival

Clinical Colorectal Cancer ◽

10.1016/j.clcc.2015.02.004 ◽

2015 ◽

Vol 14 (3) ◽

pp. 185-191 ◽

Cited By ~ 22

Author(s):

Natalie Turner ◽

Ben Tran ◽

Phillip V. Tran ◽

Mathuranthakan Sinnathamby ◽

Hui-Li Wong ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Systemic Inflammation ◽

Primary Tumor ◽

Tumor Resection ◽

Primary Tumor Resection

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Impact on survival of primary tumor resection in patients with colorectal cancer and unresectable metastasis: Pooled analysis of individual patients’ data from four randomized trials.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3507 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3507-3507 ◽

Cited By ~ 8

Author(s):

Matthieu Faron ◽

Abderrahmane Bourredjem ◽

Jean-Pierre Pignon ◽

Olivier Bouche ◽

Jean-Yves Douillard ◽

...

Keyword(s):

Primary Tumor ◽

Tumor Resection ◽

Tumor Location ◽

Primary Tumor Resection ◽

First Line ◽

Primary Tumor Location ◽

Impact On Survival ◽

Colonic Primary ◽

Unresectable Metastasis ◽

Line Chemotherapy

3507 Background: In patients with colorectal cancer (CRC) and unresectable metastasis, the prognostic impact of primary tumor resection still remains a matter of debates. The goal of this study was to estimate, after adjustment for prognostic factors, the effect of primary tumor resection on survival. Methods: Individual patients’ data of the 1155 patients with metastatic CRC included in 4 first-line chemotherapy trials (FFCD 9601, FFCD 2000-05, ACCORD 13 and ML 16987) where retrieved. Patients were eligible for this study if they had synchronous metastasis judged unresectable. Primary endpoint was overall survival (OS), secondary endpoint was progression free survival (PFS). A Cox proportional hazard model stratified on the trial was used to estimate the impact on survival. Results: 810 patients beginning first-line chemotherapy with either fluoropyrimidine alone, oxaliplatin, irinotecan and/or bevacizumab were eligible. Patients with a history of resection (n = 478 (59%)), as compared to those without (n = 332 (41%)), were more likely to have colonic primary (p < 0.0001), lower carcino embryonic antigen (CEA) (p < 0.0001) or alkaline phosphatase (ALP) level (p=0.04) and normal white blood cell count (WBC) (p < 0.0001). In the univariate analysis, stratified on the trial, primary tumor resection was associated with a better OS (Hazard Ratio HR: 0.73 [0.63-0.84]; p < 0.0001) and PFS (HR : 0.73 [0.63-0.84]; p < 0.0001). Multivariate analysis, adjusted for primary tumor location, CEA, ALP and WBC levels, OMS performance status and number of metastatic sites confirmed that primary tumor resection was an independent predictor of better OS (HR : 0.63 [0.53-0.75] ; p < 0.0001), and PFS (HR : 0.82 [0.70-0.95] ; p = 0.0007). Significant interactions were found between resection and CEA level (p=0.02) and resection and primary tumor location (p=0.01) for OS (not for PFS) with a lower impact of resection with higher CEA levels or a colonic primary. Conclusions: This study confirmed the independent prognostic value on survival of primary tumor resection in patients with unresectable metastases of CRC.

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