Abstract
BackgroundIt remains controversial whether palliative primary tumor resection (PPTR) can provide survival benefits to the patients with metastatic colorectal cancer (mCRC) who have unresectable metastases. The aim of this study was to evaluate whether PPTR could improve the survival of patients with mCRC.MethodsWe conducted a retrospective study on consecutive mCRC patients with unresectable metastases who were diagnosed at Sun Yat-sen University Cancer Center in Guangzhou, Guangdong, China, between January 2005 and December 2012. Overall survival (OS) and progression-free survival (PFS) after first-line chemotherapy failure were compared between the PPTR and non-PPTR patient groups.ResultsA total of 387 patients were identified, including 254 who underwent PPTR and 133 who did not. The median OS of the PPTR and non-PPTR groups was 20.8 and 14.8 months (P < 0.001), respectively. The median PFS after first-line chemotherapy was 7.3 and 4.8 months (P < 0.001) in the PPTR and non-PPTR groups, respectively. A larger proportion of patients in the PPTR group (219 of 254, 86.2%) showed local progression compared with that of patients in the non-PPTR group (95 of 133, 71.4%; P < 0.001). Only patients with normal lactate dehydrogenase (LDH) levels and with carcinoembryonic antigen (CEA) levels <70 ng/mL benefited from PPTR (median OS, 22.2 months for the PPTR group and 16.2 months for the non-PPTR group; P < 0.001).ConclusionsFor mCRC patients with unresectable metastases, PPTR can improve OS and PFS after first-line chemotherapy and decrease the incidence of new organ involvement. However, PPTR should be recommended only for patients with normal LDH levels and with CEA levels <70 ng/mL.
Highlights
It remains controversial whether palliative primary tumor resection (PPTR) can provide survival benefits to the patients with metastatic colorectal cancer who have unresectable metastases
We evaluated the prognostic values of all the factors, including age, sex, primary tumor location, metastatic site, regimen of first-line chemotherapy, and alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and carcinoembryonic antigen (CEA) levels (Table 2)
We found that patients did not benefit from PPTR if they had CEA levels >70 ng/mL. Since both LDH and CEA levels showed the potential to be used for selecting patients who could benefit from PPTR, we investigated whether a combination of the two indexes could provide a better predictive model
Summary
It remains controversial whether palliative primary tumor resection (PPTR) can provide survival benefits to the patients with metastatic colorectal cancer (mCRC) who have unresectable metastases. Curative surgery, including eradication of both the primary cancer and the metastatic lesions, can be successful in patients with limited metastasis, most patients remain incurable owing to unresectable metastases [3]. For such patients, both the National Comprehensive Cancer Network and the European Society for Medical Oncology recommend chemotherapy without primary cancer resection except in cases of intestinal perforation, intestinal obstruction, or other emergencies [4]. The reliability of comparing one study with another is inevitably challenged by patient selection bias
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