The Role of Primary Tumor Resection in Patients with Pleural Metastasis Encountered at the Time of Surgery

e15642 Background: Patients with metastatic hepatocellular carcinoma (HCC) are diagnosed more frequently because of introduction of increasingly sensitive imaging modalities. The majority of these patients die of progressive intrahepatic tumor but not due to extrahepatic metastasis. There has been little information about the role of primary tumor resection (PTR) for metastatic HCC patients with resectable primary tumor. Methods: Metastatic HCC patients recommended PTR were identified in SEER registry between 2004 and 2013. The effect of PTR on overall and cancer-specific survival (OS and CSS) using log-rank test and Cox proportional hazard regression model, as well as propensity score matching was assessed. Additionally, validation was performed in another cohort from Sun Yat-sen Memorial hospital (n = 131). Results: Overall, 529 metastatic HCC patients with resectable primary tumor were included. Of those 230 patients underwent PTR but 299 did not. The percentage of PTR among resectable metastatic HCCs increased from 38.6% in 2004 to 70.3% in 2013. PTR was associated with improved OS (hazard ratio (HR) 0.310, 95% CI 0.241-0.400, P< 0.001) and CSS (HR 0.326, 95% CI 0.250-0.425, P< 0.001) in the propensity score- matched patients. This improvement in outcomes remained significant after sensitivity analyses using multiple imputation. Furthermore, consistent with observations in SEER, PTR was correlated with improved OS (HR 0.496, 95% CI 0.294-0.838, P= 0.009) and CSS (HR 0.538, 95% CI 0.307-0.945, P= 0.031) in the validation cohort from Sun Yat-sen Memorial hospital. Conclusions: This study, the first population-based analysis using propensity score matching and multiple imputation, demonstrated that PTR has a favorable impact on prognosis in patients with metastatic HCC. Further prospective randomized trials is needed to conclusively determine whether metastatic HCC patients with resectable primary tumor should be offered aggressive locoregional surgery.

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Pelvic radiotherapy in combination with radical resection of the primary tumor improves survival in patients with metastatic rectal adenocarcinoma: A national cancer database analysis (NCDB).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.714 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 714-714

Author(s):

Paul B. Renz ◽

Shaakir Hasan ◽

Rodney E Wegner ◽

Gene Grant Finley ◽

Dulabh K. Monga ◽

...

Keyword(s):

Surgical Resection ◽

Primary Tumor ◽

Tumor Resection ◽

Rectal Adenocarcinoma ◽

Primary Tumor Resection ◽

Pelvic Radiotherapy ◽

Risk Of Death ◽

Metastatic Setting

714 Background: With recent advances in systemic therapies and increased survival of patients with metastatic rectal cancer, the role of primary tumor resection may be of increased importance and is often debated. However, the role of combining radiotherapy to surgical resection in the metastatic setting is unknown. Accordingly, we utilized the NCDB to quantify survival in metastatic rectal adenocarcinoma patients with primary tumor resection with and without pelvic radiotherapy. Methods: Of the 15,643 Stage IV rectal adenocarcinoma patients receiving chemotherapy from 2004 to 2014, 4051 patients had primary tumor resection with sufficient follow up for analysis. Patients were stratified by receipt of pelvic radiotherapy (n = 1882) or no pelvic radiotherapy (n = 2169). Univariable/multivariable analyses and propensity-adjusted Cox proportional hazard ratios for survival were performed. Results: Median age was 63 years (18-90) with median follow up of 32.3 months (3.02-151.29). There were more patients with T3/T4 disease (69.6% vs 46.5%) or N1 disease (41.5% vs 27.3%) in the surgery plus radiotherapy arm. Metastatic burden was confined to one organ in 40.5% of patients and was equally distributed between radiotherapy and non-radiotherapy groups (OR 0.92; 95%CI 0.81-1.04). Median survival was 46.3 months vs. 35.3 months in favor of adding radiotherapy (p < 0.001). The 2, 5 and 10-year overall survival were 68.4%, 24.8%, and 9.5% for surgical resection alone compared to 77.2%, 39.6%, and 22.3% for surgery + radiotherapy. On multivariable analysis radiotherapy was associated with a statistically significant reduction in the risk of death (HR 0.718; 95% CI 0.661-0.780). This benefit was upheld on propensity matched analysis (HR 0.722; 95% CI 0.0665-0.784). Conclusions: Our study indicates that adding radiotherapy to surgical management of the primary tumor in patients receiving systemic chemotherapy for metastatic rectal adenocarcinoma improves survival. Prospective investigation of the management of the rectal primary tumor with chemotherapy, pelvic radiotherapy, and surgical resection is warranted.

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Primary Tumor Resection Improves Survival for EGFR-TKI-Treated Patients With Occult M1a Lung Adenocarcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.622723 ◽

2021 ◽

Vol 11 ◽

Author(s):

Fangqiu Fu ◽

Zhexu Wen ◽

Zhendong Gao ◽

Yue Zhao ◽

Yuan Li ◽

...

Keyword(s):

Targeted Therapy ◽

Lung Adenocarcinoma ◽

Primary Tumor ◽

Tumor Resection ◽

Primary Tumor Resection ◽

Cancer Center ◽

Never Smokers ◽

Survival Differences ◽

Egfr Tkis

BackgroundThe role of primary tumor resection in occult M1a lung adenocarcinoma remains unclear, especially for patients receiving targeted therapy. The purpose of this study is to assess the effect of primary tumor resection on overall survival (OS) in lung adenocarcinoma patients with occult pleural disseminations receiving targeted therapy.MethodsLung adenocarcinoma patients with intraoperatively-confirmed occult pleural dissemination (M1a), who hospitalized in the Department of Thoracic Surgery in Fudan Shanghai Cancer Center from May 2008 to December 2017 and received EGFR-TKIs therapy, were enrolled. Log-rank tests were used to compare the survival differences between groups.Results34 patients receiving EGFR-TKIs were enrolled. The majority of them were never smokers (29/34, 85.3%). Among the enrolled patients, 20 (58.8%) patients underwent primary tumor resection, while 14 (41.2%) patients not. There was no distributional difference of baselines between patients undergoing and not undergoing primary tumor resection. Further analyses demonstrated that the patients undergoing primary tumor resection had a prolonged OS compared with those not (log-rank P= 0.042). The 2-year and 5-year OS for patients receiving primary tumor resection and EGFR-TKIs was 90.0% and 60.1%.ConclusionsPrimary tumor resection was associated with improved survival in patients with occult intraoperatively-confirmed M1a adenocarcinoma receiving EGFR-TKIs.

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