Survival outcome of palliative primary tumor resection for colorectal cancer patients with synchronous liver and/or lung metastases: A retrospective cohort study in the SEER database by propensity score matching analysis. (August 2020)

• Record Type: Journal Article
• Authors: Chen, Xianzhe; Hu, Weixian; Huang, Chengzhi; Liang, Weijun; Zhang, Jie; Wu, Deqing; Lv, Zejian; Li, Yong; Luo, Yuwen; Liang, Zongyu; Wang, Minjia; Wang, Junjiang; Yao, Xueqing
• Is Part Of: International journal of surgery. Volume 80(2020)
• Page Start: 135
• Page End: 152
• Publication Date: 2020-08
• Subjects: Palliative primary tumor resection -- Colorectal cancer -- Synchronous liver and/or lung metastases -- Propensity score matching analysis -- SEER database; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2020.06.024
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: There is a great matter of controversies whether some of these synchronous metastatic colorectal cancer patients can benefit from palliative primary tumor resection (pPTR) and there is still no reported randomized control trial to address this issue. Methods: Patients with microscopically proven metastatic colorectal cancer were identified within the SEER database (2010–2016). Patients were propensity matched 1:1 into pPTR and non-surgery groups and among the matched cohort, the univariable and multivariable Cox proportional hazards regression models were performed to identify predictors of survival. Median survival was calculated by using the Kaplan-Meier method. Results: Of 21, 405 colorectal cancer patients diagnosed with synchronous liver and/or lung metastases, 7386 were identified in the matched cohort. The median overall survival was 12.0 months, 22.0 months in the non-surgery, surgery groups, respectively (p < 0.001) and the corresponding median cancer-specific survival was 13.0 months, 22.0 months, respectively (p < 0.001). Multivariable Cox regression analysis demonstrated that surgery was independently associated with improved overall survival (hazard ratio, 0.531) as well as cancer-specific survival (hazard ratio, 0.516). In stratified analyses by primary site and patterns of distant metastases, those patients with pPTR had better prognosis. In addition, stratified analysis revealed that trimodality therapy was linked with the greatest therapeutic effect followed by addition of chemotherapy to pPTR. Conclusions: pPTR may offer some therapeutic benefits among carefully selected patients, and surgery-based multimodality therapy was associated with better survival. Highlights: Whether palliative primary tumor resection is beneficial to metastatic colorectal cancer is unknown. Propensity score matching analysis of Surveillance, Epidemiology, and End Results Database. Explore the effect surgery interaction with other therapies on survival. Focus on common metastatic sites of colorectal cancer patients.