Prognostic importance of primary tumor resection in patients with advanced colorectal cancer (CRC): A Canadian province’s experience

Abstract

14529 Background: Surgical resection (SR) of primary tumor in patients with newly diagnosed advanced CRC remains controversial. Limited data is available regarding potential benefit of resection in these patients. We performed a population-based study to determine the prognostic value of SR of primary tumor in patients with metastatic CRC. Methods: Medical records of patients with metastatic CRC diagnosed between 1991–2000 in the province of Saskatchewan were reviewed. Patients with unresectable T4M0 disease were excluded. A multivariate analysis was performed using Cox regression model and various clinicopathologic variables were tested for their prognostic significance. Kaplan-Meier curves were used to determine survival. A preliminary analysis of data of 212 eligible patients diagnosed between 1998–2000 is presented here. Results: Patients median age was 71 yrs (33–94) and M:F was 1:0.77. One hundrad thirty one (62%) patients underwent SR for the primary tumor. Among 131 patients, 76 (58%) were operated for tumor related symptoms (36% obstruction, 14% perforation, and 9% bleeding). Six percent patients died of postoperative complications. Of 212 patients, 36% received 5FU-based chemotherapy (46% patients with SR) and 17% received a second line therapy. Median overall survival (OS) of all patients was 6.7 months. Patients who underwent SR of primary tumor had a significantly better median OS of 11 months compared with 3 months in patients who did not have surgery (HR 0.47; 95% CI 0.29–0.76). Patients who underwent SR and had received chemotherapy had a median OS of 14.8 months compared with median OS of 6 months if they did not receive chemotherapy (HR, 0.29; 95% CI 0.15–0.55). In addition to 5FU-based chemotherapy and SR of primary tumor; metastectomy, age >65 yrs, elevated alkaline phosphatase level and thrombocytosis were other important variables that were correlated with survival in patients with advanced CRC. Conclusions: SR of primary tumor has been associated with significant improvement in survival independent of systemic chemotherapy in patients with advanced CRC. Further analysis of data in patients diagnosed between 1991–2000 is planned to confirm these findings in a larger group of patients. No significant financial relationships to disclose.