Benefit of primary tumor resection in stage IV colorectal cancer with unresectable metastasis: a multicenter retrospective study using a propensity score analysis

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• 作者：Soichiro Ishihara ; Takeshi Nishikawa…
• 关键词：Colorectal cancer ; Stage IV ; Primary tumor resection ; Propensity score analysis
• 刊名：International Journal of Colorectal Disease
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：30
• 期：6
• 页码：807-812
• 全文大小：254 KB
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• 作者单位：Soichiro Ishihara (1)
  Takeshi Nishikawa (1)
  Toshiaki Tanaka (1)
  Junichiro Tanaka (1)
  Tomomichi Kiyomatsu (1)
  Kazushige Kawai (1)
  Keisuke Hata (1)
  Hioaki Nozawa (1)
  Shinsuke Kazama (1)
  Hironori Yamaguchi (1)
  Eiji Sunami (1)
  Joji Kitayama (1)
  Kenichi Sugihara (2)
  Toshiaki Watanabe (1)
  
  1. Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
  2. Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Internal Medicine
  Gastroenterology
  Hepatology
  Proctology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1262

文摘

Purpose Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer (CRC) with unresectable metastasis (mCRC). The aim of this study was to investigate the prognostic impact of primary tumor resection in various subgroups of mCRC patients. Methods A total of 1982 patients with mCRC from January 1997 to December 2007 were retrospectively evaluated. The impact of primary tumor resection on cancer-specific survival (CSS) was analyzed using propensity score analysis to mitigate selection bias. Covariates in the models for propensity scores included treatment period, age, gender, tumor location, depth, lymph node metastasis, number of metastatic organs, and carcinoembryonic antigen (CEA) levels. Results Among the whole patient population, primary tumor resection significantly improved CSS [hazard ratio (HR) 0.46, 95?% confidence interval (CI) 0.32-.66, p-lt;-.01]. However, primary tumor resection did not significantly improve CSS in the following subgroups: patients treated in the first 5?years of the study (HR 0.56, 95?% CI 0.28-.13, p--.08), patients aged >65?years (HR 0.72, 95?% CI 0.36-.42, p--.31), female patients (HR 0.60, 95?% CI 0.31-.17, p--.13), patients with right-sided colon cancer (HR 0.68, 95?% CI 0.39-.20, p--.17), and patients without nodal involvement (HR 0.54, 95?% CI 0.25-.17, p--.09). Conclusions Our study suggests that primary tumor resection improves the survival of patients with mCRC. However, the prognostic benefit is different among patient subpopulations.