Abstract
ObjectiveThe role of surgery in metastatic colorectal cancer (mCRC) remains controversial. This study was performed to assess the impact of surgery on survival in metastatic colorectal cancer.Materials and MethodsInformation of mCRC patients diagnosed between January 1, 2004, and December 31, 2013, was retrieved from the Surveillance, Epidemiology, and End Results Program database. Patients were classified in three groups: patients undergoing resection of both primary and distant metastatic tumors (group ‘PMTR’), patients receiving primary tumor resection alone (group ‘PTR’) and patients not undergoing any surgery (group ‘No resection’). Kaplan-Meier method and multivariate Cox proportional hazard regression analysis were applied to estimate disease specific survival time (DSS) and determine prognostic factors.ResultsA total of 38,591 mCRC patients were eligible. Overall, median DSS of group ‘PMTR’ was significantly longer compared with group ‘PTR’ and group ‘No resection’ (28.0 vs 21.0 vs 11.0 months, P < 0.001). Stratified analysis observed that primary tumor in left-sided colorectal cancer (LCRC) was a favorable prognostic factor compared with right-sided colorectal cancer (RCRC) (median DSS of LCRC: PMTR, 34 months, PTR, 25 months, No resection, 13 months; median DSS of RCRC: PMTR, 20 months, PTR, 16 months, No resection, 8 months; P < 0.001). Multivariate analysis demonstrated that surgery was an independent prognostic factor for better survival (PMTR, HR = 0.403, 95% CI 0.384–0.423, P < 0.001; PTR, HR = 0.515, 95% CI 0.496–0.534, P < 0.001). Furthermore, in patients undergoing surgery, patients with younger age, female, married status, LCRC and lower CEA level were prone to receiving PMTR.ConclusionsThis analysis demonstrated that surgery was an independent prognostic factor for improved survival in mCRC. Patients with LCRC had better survival than patients with RCRC after surgery.
Highlights
The statistics of World Health Organization (WHO) have shown that colorectal cancer (CRC) is the third most common malignancy worldwide and the fourth leading cause of cancer-related deaths [1]
Stratified analysis observed that primary tumor in left-sided colorectal cancer (LCRC) was a favorable prognostic factor compared with right-sided colorectal cancer (RCRC)
Multivariate analysis demonstrated that surgery was an independent prognostic factor for better survival (PMTR, hazard ratio (HR) = 0.403, 95% confidence interval (CI) 0.384–0.423, P < 0.001; PTR, HR = 0.515, 95% CI 0.496–0.534, P < 0.001)
Summary
The statistics of World Health Organization (WHO) have shown that colorectal cancer (CRC) is the third most common malignancy worldwide and the fourth leading cause of cancer-related deaths [1]. According to the Surveillance, Epidemiology, and End Results Program (SEER) cancer statistics, about 20% of CRC patients have distant metastases at the time of initial diagnosis, with a 5-year survival rate of 13.1% [2]. For patients with resectable liver and lung metastases, studies indicated that radical resection of primary and metastatic tumors have significant survival benefit [3,4,5,6]. Taking liver metastatic CRC as an example, a recent retrospective study reported a median 5-year survival rate of 38% in CRC patients with hepatic metastases who had undergone complete resection of primary tumor and liver metastases [7]. Analysis showed that metastatic CRC (mCRC) patients with solitary liver metastases had a 5-year survival rate as high as 71% [8]. It is important to find out molecular and clinical predictive factors associated with surgery in mCRC patients
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