ASO Visual Abstract: Timing of Primary Tumor Resection in Synchronous Metastatic Colon Cancer Patients Undergoing Hepatic Arterial Infusion Pump Placement

Introduction: 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. Methods: 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. Results: 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 (p = 0.45). Conclusion: Our data suggest that the prognostic value of PTR is independent of sidedness. Validation of these results will be performed in ongoing RCTs.

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Primary Tumor Resection and Multimodality Treatment for Patients with Metastatic Colon Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-015-5073-3 ◽

2016 ◽

Vol 23 (6) ◽

pp. 1815-1823 ◽

Cited By ~ 6

Author(s):

Nader N. Massarweh ◽

Linda T. Li ◽

Shubhada Sansgiry ◽

David H. Berger ◽

Daniel A. Anaya

Keyword(s):

Colon Cancer ◽

Primary Tumor ◽

Tumor Resection ◽

Multimodality Treatment ◽

Primary Tumor Resection ◽

Metastatic Colon Cancer

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Resection of primary tumor in patients who present with stage IV colon cancer may result in improved survival.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.726 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 726-726 ◽

Cited By ~ 1

Author(s):

Aaron Lewis ◽

Rebecca A. Nelson ◽

Lily L. Lai

Keyword(s):

Colon Cancer ◽

Cancer Patients ◽

Primary Tumor ◽

Tumor Resection ◽

Stage Iv ◽

Primary Tumor Resection ◽

Primary Tumors ◽

Risk Of Disease ◽

Disease Specific ◽

Overall Mortality

726 Background: Resection of the primary cancer in patients with metastatic disease has been shown to result in improved survival in cancers such as renal cell carcinoma. Currently, the impact primary tumor resection has on survival in stage IV colon cancer patients is unknown. Methods: The SEER dataset was queried for patients who presented with histologically confirmed, stage IV colon cancer from 1998-2011. We excluded patients with rectal cancer, multiple primary tumors, age <18 or >90 years, diagnosis upon autopsy/death record, mortality within 30 days of diagnosis, or resection of other tumor sites (regional or distant). Cox proportional hazard models were used to assess demographic and clinical factors predictive of disease specific and overall survival. To limit group differences, a 1:1 matched analysis was also performed on patients who underwent primary resection compared to patients who did not. Results: A total of 28,068 stage IV colon cancer patients were evaluated, of which 70.3% underwent resection. Among the variables studied, multivariate models showed that patients who underwent primary tumor resection were at lower risk of disease-specific and overall mortality, with hazard ratios (HR) of 0.44 (0.43-0.46) and 0.45 (0.43-0.47), respectively. In the matched analysis (n=5,410 in each group), patients who underwent resection of the primary tumor remained at decreased risk of disease-specific and overall mortality, HR 0.48 (0.45-0.52) and 0.49 (0.46-0.53), respectively. The median survival and 3-year survival after matching was 17 and 9 months and 23% and 6% in the resection and nonresection groups, respectively, p<0.0001. Conclusions: The majority (70.3%) of patients in the United States with stage IV colon cancer undergo resection of primary tumors. Analyses of SEER data suggests that resection of the primary tumor may result in improved DSS and OS in patients with stage IV colon cancer. A prospective, randomized trial is warranted to confirm a survival benefit.

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Relapsed Colon Cancer Patient Presenting With Hematuria 13 Years After Primary Tumor Resection: A Case Report

The Kaohsiung Journal of Medical Sciences ◽

10.1016/s1607-551x(10)70031-0 ◽

2010 ◽

Vol 26 (4) ◽

pp. 211-216

Author(s):

Yu-Ho Huang ◽

Hsiang-Lin Tsai ◽

Chee-Yin Chai ◽

Jaw-Yuan Wang

Keyword(s):

Colon Cancer ◽

Case Report ◽

Cancer Patient ◽

Primary Tumor ◽

Tumor Resection ◽

Colon Cancer Patient ◽

Primary Tumor Resection

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Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer

Cancer ◽

10.1002/cncr.30230 ◽

2016 ◽

Vol 123 (7) ◽

pp. 1124-1133 ◽

Cited By ~ 26

Author(s):

Zeinab Alawadi ◽

Uma R. Phatak ◽

Chung-Yuan Hu ◽

Christina E. Bailey ◽

Y. Nancy You ◽

...

Keyword(s):

Colon Cancer ◽

Primary Tumor ◽

Comparative Effectiveness ◽

Tumor Resection ◽

Stage Iv ◽

Primary Tumor Resection

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Primary Tumor Resection in Metastatic Colon Cancer: A Propensity Score Analysis of the National Cancer Data Base

Journal of Surgical Research ◽

10.1016/j.jss.2013.11.664 ◽

2014 ◽

Vol 186 (2) ◽

pp. 641

Author(s):

U.R. Phatak ◽

C. Hu ◽

Y. You ◽

B.W. Feig ◽

J.M. Skibber ◽

...

Keyword(s):

Colon Cancer ◽

Propensity Score ◽

Data Base ◽

Primary Tumor ◽

Propensity Score Analysis ◽

Tumor Resection ◽

National Cancer Data Base ◽

Metastatic Colon Cancer ◽

Cancer Data ◽

Score Analysis

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Comparative effectiveness of primary tumor resection in metastatic colon cancer: An instrumental variable analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.674 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 674-674 ◽

Cited By ~ 1

Author(s):

Zeinab Alawadi ◽

Uma Phatak ◽

Chung-Yuan Hu ◽

Christina Edwards Bailey ◽

Lillian Kao ◽

...

Keyword(s):

Colon Cancer ◽

Regression Analysis ◽

Primary Tumor ◽

Instrumental Variable ◽

Survival Benefit ◽

Cox Regression ◽

Tumor Resection ◽

Metastatic Colon Cancer ◽

Landmark Analysis ◽

Treatment Bias

674 Background: Although the safety of chemotherapy without primary tumor resection (PTR) has been established, questions remain regarding potential survival benefit with PTR. The purpose of this study was to compare mortality with and without PTR among patients with unresectable metastatic colon cancer using nationwide hospital based cancer registry data. Methods: An observational study was conducted of patients with stage 4 colon cancer identified from the National Cancer Data Base (2003-2005). Patients who underwent metastectomy were excluded. Patient, treatment, and hospital data were analyzed. Multivariate Cox regression stratified by receipt of chemotherapy was performed to compare survival with and without PTR. To account for treatment selection bias, Propensity Score Weighting (PSW) and Instrumental Variable (IV) analyses, using hospital-level PTR rate as the instrument, were performed. In order to account for the potential bias associated with early comorbidity or disease burden associated deaths (survivor treatment bias), 1 year landmark analysis was performed. Results: A total of 14,399 patients met inclusion criteria and 6,735 patients were eligible for landmark analysis. PTR was performed in 38.2% of the total cohort and 73.8% of those at landmark. Using multivariate Cox regression analysis, PTR was associated with a significant reduction in mortality (HR 0.39; 95% CI, 0.38-0.41). This effect persisted with PSW (HR 0.4; 95% CI, 0.38-0.43). However, IV analysis showed a much smaller effect, (RR 0.88; 95% CI, 0.83-0.93). While a smaller benefit was seen on landmark analysis using multivariate Cox regression (HR 0.6; 95% CI, 0.55-0.64) and PSW (HR 0.59; 95% CI, 0.54-0.64), IV analysis showed no improvement in survival with PTR (RR 0.97; 95% CI, 0.87-1.06). Stratification by chemotherapy did not alter the results. Conclusions: Among patients with stage IV colon cancer, PTR offered no survival benefit over systemic chemotherapy alone when the IV method was applied at the 1 year landmark. Subject to selection and survivor treatment bias, standard regression analysis may overestimate the benefit of PTR. Future study should focus on identifying patients most likely to benefit from PTR.

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