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01-09-2014 | Colorectal Cancer

Prognostic Impact of Primary Tumor Resection and Lymph Node Dissection in Stage IV Colorectal Cancer with Unresectable Metastasis: A Propensity Score Analysis in a Multicenter Retrospective Study

Authors: Soichiro Ishihara, MD, PhD, Tamuro Hayama, MD, PhD, Hideki Yamada, MD, PhD, Keijiro Nozawa, MD, PhD, Keiji Matsuda, MD, PhD, Hiroaki Miyata, PhD, Satomi Yoneyama, MD, PhD, Toshiaki Tanaka, MD, PhD, Junichiro Tanaka, MD, PhD, Tomomichi Kiyomatsu, MD, PhD, Kazushige Kawai, MD, PhD, Hioaki Nozawa, MD, PhD, Takamitsu Kanazawa, MD, PhD, Shinsuke Kazama, MD, PhD, Hironori Yamaguchi, MD, PhD, Eiji Sunami, MD, PhD, Joji Kitayama, MD, PhD, Yojiro Hashiguchi, MD, PhD, Kenichi Sugihara, MD, PhD, Toshiaki Watanabe, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2014

Abstract

Background

Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer with unresectable metastasis (mCRC). Prognostic significance of lymph node dissection (LND) in mCRC has not been examined previously. The aim of this study was to investigate the prognostic impact of primary tumor resection and LND in mCRC.

Methods

A total of 1,982 patients with mCRC from January 1997 to December 2007 were retrospectively studied. The impact of primary tumor resection and LND on overall survival (OS) was analyzed using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Covariates in the models for propensity scores included treatment period, institution, age, sex, carcinoembryonic antigen, tumor location, histology, depth, lymph node metastasis, lymphovascular invasion, and number of metastatic organs.

Results

In a multivariate analysis, primary tumor resection and treatment in the latter period were associated with an improved OS, and age over 70 years, female sex, lymph node metastasis, and multiple organ metastasis were associated with a decreased OS. In the propensity-matched cohort, patients treated with primary tumor resection showed a significantly better OS than those without tumor resection (median OS 13.8 vs. 6.3 months; p = 0.0001). Furthermore, among patients treated with primary tumor resection, patients treated with D3 LND showed a significantly better OS than those with less extensive LND (median OS 17.2 vs. 13.7 months; p < 0.0001).

Conclusions

It was suggested that primary tumor resection with D3 LND improves the survival of patients with mCRC.

Nitzkorski JR, Farma JM, Watson JC, et al. Outcome and natural history of patients with stage IV colorectal cancer receiving chemotherapy without primary tumor resection. Ann Surg Oncol. 2012;19(2):379–383.PubMedCrossRef

Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17(1):1–29.PubMedCrossRef

Ruo L, Gougoutas C, Paty PB, Guillem JG, Cohen AM, Wong WD. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg. 2003;196(5):722–728.PubMedCrossRef

Verhoef C, de Wilt JH, Burger JW, Verheul HM, Koopman M. Surgery of the primary in stage IV colorectal cancer with unresectable metastases. Eur J Cancer. 2011;47 Suppl 3:S61–66.PubMedCrossRef

Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis. 2009;11(4):354–364; discussion 364–355.

West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28(2):272–278.PubMedCrossRef

Kanehara S. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. 7th ed. Kanehara & co:Tokyo; 2006.

Stelzner S, Hellmich G, Koch R, Ludwig K. Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol. 2005;89(4):211–217.PubMedCrossRef

Grothey A, Sugrue MM, Purdie DM, et al. Bevacizumab beyond first progression is associated with prolonged overall survival in metastatic colorectal cancer: results from a large observational cohort study (BRiTE). J Clin Oncol. 2008;26(33):5326–5334.PubMedCrossRef

10.

Tournigand C, Andre T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22(2):229–237.PubMedCrossRef

11.

Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23):2335–2342.PubMedCrossRef

12.

Lee WS, Baek JH, Kang JM, Choi S, Kwon KA. The outcome after stent placement or surgery as the initial treatment for obstructive primary tumor in patients with stage IV colon cancer. Am J Surg. 2012;203(6):715–719.PubMedCrossRef

13.

Sabbagh C, Browet F, Diouf M, et al. Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg. 2013;258(1):107–115.PubMedCrossRef

14.

Venderbosch S, de Wilt JH, Teerenstra S, et al. Prognostic value of resection of primary tumor in patients with stage IV colorectal cancer: retrospective analysis of two randomized studies and a review of the literature. Ann Surg Oncol. 2011;18(12):3252–3260.PubMedCentralPubMedCrossRef

15.

Slanetz CA Jr, Grimson R. Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon Rectum. 1997;40(10):1205–1218;discussion 1218–1209.

16.

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–318;discussion 318–321.

17.

Battaglia A, Buzzonetti A, Baranello C, et al. Metastatic tumour cells favour the generation of a tolerogenic milieu in tumour draining lymph node in patients with early cervical cancer. Cancer Immunol Immunother. 2009;58(9):1363–1373.PubMedCrossRef

18.

Deng L, Zhang H, Luan Y, et al. Accumulation of foxp3+T regulatory cells in draining lymph nodes correlates with disease progression and immune suppression in colorectal cancer patients. Clin Cancer Res. 2010;16(16):4105–4112.PubMedCrossRef

19.

Boissonnas A, Scholer-Dahirel A, Simon-Blancal V, et al. Foxp3+T cells induce perforin-dependent dendritic cell death in tumor-draining lymph nodes. Immunity. 2010;32(2):266–278.PubMedCrossRef

20.

Stillwell AP, Buettner PG, Ho YH. Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg. 2010;34(4):797–807.PubMedCrossRef

21.

Little RJ, Rubin DB. Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. Ann Rev Public Health. 2000;21:121–145.CrossRef

22.

Ahmed S, Howel D, Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer. J Geriatr Oncol. 2014;5(2):133–140.PubMedCrossRef

23.

van Leersum NJ, Janssen-Heijnen ML, Wouters MW, et al. Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995-2010. Int J Cancer. 2013;132(9):2157–2163.PubMedCrossRef

Title: Prognostic Impact of Primary Tumor Resection and Lymph Node Dissection in Stage IV Colorectal Cancer with Unresectable Metastasis: A Propensity Score Analysis in a Multicenter Retrospective Study
Authors: Soichiro Ishihara, MD, PhD
Tamuro Hayama, MD, PhD
Hideki Yamada, MD, PhD
Keijiro Nozawa, MD, PhD
Keiji Matsuda, MD, PhD
Hiroaki Miyata, PhD
Satomi Yoneyama, MD, PhD
Toshiaki Tanaka, MD, PhD
Junichiro Tanaka, MD, PhD
Tomomichi Kiyomatsu, MD, PhD
Kazushige Kawai, MD, PhD
Hioaki Nozawa, MD, PhD
Takamitsu Kanazawa, MD, PhD
Shinsuke Kazama, MD, PhD
Hironori Yamaguchi, MD, PhD
Eiji Sunami, MD, PhD
Joji Kitayama, MD, PhD
Yojiro Hashiguchi, MD, PhD
Kenichi Sugihara, MD, PhD
Toshiaki Watanabe, MD, PhD
Publication date: 01-09-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 9/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3719-1

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Prognostic Impact of Primary Tumor Resection and Lymph Node Dissection in Stage IV Colorectal Cancer with Unresectable Metastasis: A Propensity Score Analysis in a Multicenter Retrospective Study

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

Methods

Results

Conclusions

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