Korean J Gastroenterol.  2020 Jul;76(1):17-27. 10.4166/kjg.2020.76.1.17.

Survival Benefit of Palliative Primary Tumor Resection Based on Tumor Location in Patients with Metastatic Colorectal Cancer: A Single-center Retrospective Study

Affiliations
  • 1Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

Abstract

Background/Aims
The molecular underpinnings of colorectal cancer (CRC) vary according to the tumor location. The advantages of a palliative primary tumor resection in patients with metastatic CRC are controversial. This study examined the survival outcomes of a palliative primary tumor resection based on the tumor location in patients with metastatic CRC.
Methods
The medical records of 600 patients diagnosed with metastatic CRC between January 2000 and June 2018 were reviewed retrospectively. Patients undergoing surgery for both the primary tumor and metastatic lesions were excluded. The clinical factors affecting the long-term outcomes were evaluated according to the primary tumor location, and the long-term survival was compared between patients with and without a palliative primary tumor resection. The data were analyzed using the Kaplan-Meier estimator and multivariate Cox regression models.
Results
The median follow-up duration was 18 months (interquartile range, 10-28). Patients with right-sided CRC had a poor overall- and progression-free survival compared to those with left-sided CRC. In multivariate Cox regression analysis, the palliative primary tumor resection was an independent prognostic factor predicting better overall survival in patients with metastatic CRC, regardless of the primary tumor location.
Conclusions
The primary tumor location influences the prognosis, and that a primary tumor resection can improve the overall survival in patients with metastatic CRC, regardless of the primary tumor location.

Keyword

Colorectal neoplasms; Neoplasm metastasis; Tumor location; Surgery; Prognosis

Figure

  • Fig. 1 Kaplan-Meier analysis showing the overall survival (A) and progression-free survival (B) for patients with metastatic colorectal cancer based on primary tumor location. CRC, colorectal cancer.

  • Fig. 2 Kaplan-Meier analysis showing the overall survival (A) and progression-free survival (B) for patients with right-sided colorectal cancer based on palliative primary tumor resection.

  • Fig. 3 Kaplan-Meier analysis showing the overall survival (A) and progression-free survival (B) for patients with left-sided colorectal cancer based on palliative primary tumor resection.


Reference

1. c2018. Cancer Today: data visualization tools for exploring the global cancer burden in 2018. [Internet]. International Association of Cancer Registries;Lyon: Available from:https://gco.iarc.fr/today/home. cited 2020 Mar 30.
2. Muratore A, Zorzi D, Bouzari H, et al. 2007; Asymptomatic colorectal cancer with un-resectable liver metastases: immediate colorectal resection or up-front systemic chemotherapy? Ann Surg Oncol. 14:766–770. DOI: 10.1245/s10434-006-9146-1. PMID: 17103261.
Article
3. Loupakis F, Cremolini C, Masi G, et al. 2014; Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med. 371:1609–1618. DOI: 10.1056/NEJMoa1403108. PMID: 25337750.
Article
4. Bardhan K, Liu K. 2013; Epigenetics and colorectal cancer pathogenesis. Cancers (Basel). 5:676–713. DOI: 10.3390/cancers5020676. PMID: 24216997. PMCID: PMC3730326.
Article
5. Hong SN. 2018; Genetic and epigenetic alterations of colorectal cancer. Intest Res. 16:327–337. DOI: 10.5217/ir.2018.16.3.327. PMID: 30090031. PMCID: PMC6077299.
Article
6. Loupakis F, Yang D, Yau L, et al. 2015; Primary tumor location as a prognostic factor in metastatic colorectal cancer. J Natl Cancer Inst. 107:dju427. DOI: 10.1093/jnci/dju427. PMID: 25713148. PMCID: PMC4565528.
Article
7. Tejpar S, Stintzing S, Ciardiello F, et al. 2017; Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA Oncol. 3:194–201. DOI: 10.1001/jamaoncol.2016.3797. PMID: 27722750.
8. Nishihara R, Glass K, Mima K, et al. 2017; Biomarker correlation network in colorectal carcinoma by tumor anatomic location. BMC Bioinformatics. 18:304. DOI: 10.1186/s12859-017-1718-5. PMID: 28623901. PMCID: PMC5474023.
Article
9. Yamauchi M, Morikawa T, Kuchiba A, et al. 2012; Assessment of colorectal cancer molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectum. Gut. 61:847–854. DOI: 10.1136/gutjnl-2011-300865. PMID: 22427238. PMCID: PMC3345105.
Article
10. Modest DP, Schulz C, von Weikersthal LF, et al. 2014; Outcome of patients with metastatic colorectal cancer depends on the primary tumor site (midgut vs. hindgut): analysis of the FIRE1-trial (FuFIRI or mIROX as first-line treatment). Anticancer Drugs. 25:212–218. DOI: 10.1097/CAD.0000000000000041. PMID: 24201305.
11. 2020. NCCN Clinical Practive Guidelines in Oncology. Colon Cancer ver 2.2020. [Internet]. National Comprehensive Cancer Network;Pennsylvania: Available from: https://nccn.org/professionals/physician_gls/default.aspx#colon. updated 2020 Mar 3. cited 2020 Apr 7.
12. Tarantino I, Warschkow R, Worni M, et al. 2015; Prognostic relevance of palliative primary tumor removal in 37,793 metastatic colorectal cancer patients: a population-based, propensity score-adjusted trend analysis. Ann Surg. 262:112–120. DOI: 10.1097/SLA.0000000000000860. PMID: 25373464.
13. Alawadi Z, Phatak UR, Hu CY, et al. 2017; Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer. Cancer. 123:1124–1133. DOI: 10.1002/cncr.30230. PMID: 27479827. PMCID: PMC5288308.
Article
14. 2020. NCCN Clinical Practive Guidelines in Oncology. Colon Cancer ver 2.2020. [Internet]. National Comprehensive Cancer Network;Philadelphia: Available from: https://nccn.org/professionals/physician_gls/default.aspx#colon. updated 2020 March 3. cited 2020 Apr 7.
15. Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y. 2016; The worse prognosis of right-sided compared with left-sided colon cancers: a systematic review and meta-analysis. J Gastrointest Surg. 20:648–655. DOI: 10.1007/s11605-015-3026-6. PMID: 26573851.
Article
16. Peng J, Li C, Wang F, et al. 2018; Right- and left-sided stage III colon cancers present different prognostic outcomes of oxaliplatin-based adjuvant chemotherapy after curative resection. Cancer Manag Res. 10:2095–2103. DOI: 10.2147/CMAR.S163520. PMID: 30140160. PMCID: PMC6054755.
Article
17. Kishiki T, Kuchta K, Matsuoka H, et al. 2019; The impact of tumor location on the biological and oncological differences of colon cancer:multi-institutional propensity score-matched study. Am J Surg. 217:46–52. DOI: 10.1016/j.amjsurg.2018.07.005. PMID: 30384969.
18. Ishihara S, Nishikawa T, Tanaka T, et al. 2014; Prognostic impact of tumor location in stage IV colon cancer: a propensity score analysis in a multicenter study. Int J Surg. 12:925–930. DOI: 10.1016/j.ijsu.2014.07.270. PMID: 25091400.
Article
19. Holch JW, Ricard I, Stintzing S, Modest DP, Heinemann V. 2017; The relevance of primary tumour location in patients with metastatic colorectal cancer: a meta-analysis of first-line clinical trials. Eur J Cancer. 70:87–98. DOI: 10.1016/j.ejca.2016.10.007. PMID: 27907852.
Article
20. de Mestier L, Manceau G, Neuzillet C, et al. 2014; Primary tumor resection in colorectal cancer with unresectable synchronous metastases: a review. World J Gastrointest Oncol. 6:156–169. DOI: 10.4251/wjgo.v6.i6.156. PMID: 24936226. PMCID: PMC4058723.
21. van der Burg ME, Vergote I. Gynecological Cancer Group of the EORTC. 2003; The role of interval debulking surgery in ovarian cancer. Curr Oncol Rep. 5:473–481. DOI: 10.1007/s11912-003-0008-8. PMID: 14521806.
Article
22. Flanigan RC, Salmon SE, Blumenstein BA, et al. 2001; Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 345:1655–1659. DOI: 10.1056/NEJMoa003013. PMID: 11759643.
Article
23. van der Wal GE, Gouw AS, Kamps JA, et al. 2012; Angiogenesis in synchronous and metachronous colorectal liver metastases: the liver as a permissive soil. Ann Surg. 255:86–94. DOI: 10.1097/SLA.0b013e318238346a. PMID: 22156924.
24. Holmgren L, O'Reilly MS, Folkman J. 1995; Dormancy of micrometastases:balanced proliferation and apoptosis in the presence of angiogenesis suppression. Nat Med. 1:149–153. DOI: 10.1038/nm0295-149. PMID: 7585012.
25. Peeters CF, de Waal RM, Wobbes T, Ruers TJ. 2008; Metastatic dormancy imposed by the primary tumor: does it exist in humans? Ann Surg Oncol. 15:3308–3315. DOI: 10.1245/s10434-008-0029-5. PMID: 18685897.
Article
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