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

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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Prognostic Factors of Patients Who Underwent Primary Tumor Resection in Stage IV Colorectal Cancer with Non-resectable Synchronous Metastasis

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.66.585 ◽

2013 ◽

Vol 66 (8) ◽

pp. 585-590

Author(s):

Yusuke Katayama ◽

Manabu Shiozawa ◽

Sho Sawazaki ◽

Koji Numata ◽

Masakatsu Numata ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Primary Tumor ◽

Tumor Resection ◽

Stage Iv ◽

Primary Tumor Resection ◽

Synchronous Metastasis ◽

Stage Iv Colorectal Cancer

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Surgical Outcomes and Prognostic Factors of Colorectal Cancer with Peritoneal Carcinomatosis Undergoing Primary Tumor Resection

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.2016.0133 ◽

2017 ◽

Vol 50 (8) ◽

pp. 607-613

Author(s):

Daisuke Inagaki ◽

Manabu Shiozawa ◽

Tetta Satoyoshi ◽

Yousuke Atsumi ◽

Keisuke Kazama ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Peritoneal Carcinomatosis ◽

Surgical Outcomes ◽

Primary Tumor ◽

Tumor Resection ◽

Primary Tumor Resection

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

Annals of Coloproctology ◽

10.3393/ac.2020.09.15.1 ◽

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.

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Overall survival in patients with metastatic pancreatic cancer after surgically primary tumor resected: a SEER-based nomogram analysis

10.21203/rs.2.23955/v1 ◽

2020 ◽

Author(s):

Maoen Pan ◽

Yuanyuan Yang ◽

Xiaoting Wu ◽

Heguang Huang

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Primary Tumor ◽

Cox Regression ◽

Predictive Accuracy ◽

Tumor Resection ◽

Training Group ◽

Metastatic Pancreatic Cancer ◽

Cox Regression Analysis

Abstract Background This study aimed to establish and validate a nomogram to predict overall survival in patients with metastatic pancreatic cancer (mPC) after surgically primary tumor resected. Methods All mPC patients who underwent primary tumor resection at SEER database between 2004 and 2016 were identified. We randomly assigned two-thirds of the patients to the training group and one third to the validation group. In the training group, the Kaplan–Meier survival analysis was used to analyze survival outcomes. A univariate and multivariate cox regression analysis was used to identify significant prognostic factors for establishing a nomogram. The predictive accuracy and discriminative ability were measured by the concordance index (C-index) and risk group stratification. Results A total of 742 patients were included for analysis. Four significant prognostic factors were obtained and included in the nomogram. The nomogram showed an acceptable discrimination ability (C- index:0.711) and good calibration and was further validated in the validation cohort (C- index: 0.727). The nomogram total points (NTP) had the potential to stratify patients into 2-risk groups with a median OS of 11 and 4.5 months (P < 0.001), respectively. Conclusions The nomogram can provide considerable accuracy individual prediction OS outcomes in patients with metastatic pancreatic cancer undergone primary tumor surgery and it can guide clinicians to make decisions in the clinical therapies.

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Impact of postoperative complications after primary tumor resection on survival in patients with incurable stage IV colorectal cancer: A multicenter retrospective cohort study

Annals of Gastroenterological Surgery ◽

10.1002/ags3.12433 ◽

2021 ◽

Author(s):

Yusuke Fujita ◽

Koya Hida ◽

Nobuaki Hoshino ◽

Yoshiharu Sakai ◽

Tsuyoshi Konishi ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Postoperative Complications ◽

Retrospective Cohort Study ◽

Primary Tumor ◽

Retrospective Cohort ◽

Tumor Resection ◽

Stage Iv ◽

Primary Tumor Resection ◽

Stage Iv Colorectal Cancer

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Bevacizumab Efficacy Is Influenced by Primary Tumor Resection in First-Line Treatment of Metastatic Colorectal Cancer in a Retrospective Multicenter Study

Clinical Colorectal Cancer ◽

10.1016/j.clcc.2016.04.009 ◽

2016 ◽

Vol 15 (4) ◽

pp. e165-e174 ◽

Cited By ~ 4

Author(s):

Mathilde Cabart ◽

Jean-Sébastien Frénel ◽

Loïc Campion ◽

Jean-François Ramée ◽

Olivier Dupuis ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Multicenter Study ◽

Primary Tumor ◽

Tumor Resection ◽

Primary Tumor Resection ◽

Line Treatment ◽

First Line ◽

Retrospective Multicenter Study ◽

First Line Treatment

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A nomogram based on pretreatment levels of serum bilirubin and total bile acid levels predicts survival in colorectal cancer patients

BMC Cancer ◽

10.1186/s12885-021-07805-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yinghao Cao ◽

Shenghe Deng ◽

Lizhao Yan ◽

Junnan Gu ◽

Jia Yang ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Bile Acid ◽

Bile Acids ◽

Cancer Patients ◽

Serum Bilirubin ◽

Cox Regression ◽

Total Bile Acid ◽

Cox Regression Analysis ◽

Colorectal Cancer Patients

Abstract Background Serum bilirubin and total bile acid (TBA) levels have been reported to be strongly associated with the risk and prognosis of certain cancers. Here, we aimed to investigate the effects of pretreatment levels of serum bilirubin and bile acids on the prognosis of patients with colorectal cancer (CRC). Methods A retrospective cohort of 1474 patients with CRC who underwent surgical resection between January 2015 and December 2017 was included in the study. Survival analysis was used to evaluate the predictive value of pretreatment levels of bilirubin and bile acids. X-Tile software was used to identify optimal cut-off values for total bilirubin (TBIL), direct bilirubin (DBIL) and TBA in terms of overall survival (OS) and disease-free survival (DFS). Results DBIL, TBIL, and TBA were validated as significant prognostic factors by univariate Cox regression analysis for both 3-year OS and DFS. Multivariate Cox regression analyses confirmed that high DBIL, TBIL and TBA levels were independent prognostic factors for both OS (HR: 0.435, 95% CI: 0.299–0.637, P < 0.001; HR: 0.436, 95% CI: 0.329–0.578, P < 0.001; HR: 0.206, 95% CI: 0.124–0.341, P < 0.001, respectively) and DFS (HR: 0.583, 95% CI: 0.391–0.871, P = 0.008; HR:0.437,95% CI: 0.292–0.655, P <0.001; HR: 0.634, 95% CI: 0.465–0.865, P = 0.004, respectively). In addition, nomograms for OS and DFS were established according to all significant factors, and the c-indexes were 0.819 (95% CI: 0.806–0.832) and 0.835 (95% CI: 0.822–0.849), respectively. Conclusions TBIL, DBIL and TBA levels are independent prognostic factors in colorectal cancer patients. The nomograms based on OS and DFS can be used as a practical model for evaluating the prognosis of CRC patients.

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