L de Mestier1, C Neuzillet2, A Pozet3, E Desot4, S Deguelte-Lardière5, J Volet4, M Karoui6, R Kianmanesh5, F Bonnetain3, O Bouché7. 1. Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France. Electronic address: louisdemestier@hotmail.com. 2. Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Clichy, France. 3. Unit of Methodology and Quality of Life in Oncology, EA 3181, Saint-Jacques University Hospital, Besançon, France. 4. Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France. 5. Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France. 6. Department of Digestive Surgery, Pitié-Salpetrière University Hospital, Assistance Publique Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France. 7. Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France. Electronic address: obouche@chu-reims.fr.
Abstract
AIM: To explore the survival impact of primary tumor resection (PTR) in patients with metastatic colon cancer (mCC) and unresectable metastases. METHODS: We retrospectively studied a multicenter cohort of consecutive mCC patients with unresectable metastases receiving first-line chemotherapy. A weighted Cox proportional regression model was used to balance for clinical variables associated with the probability of undergoing PTR, using inverse probability of treatment weighting (IPTW) based on a propensity score. RESULTS: Ninety-six patients were included. PTR was performed in 69 (72%). The rates of secondary resection of metastases (p = 0.02) and bevacizumab administration (p = 0.02) were higher in the PTR group. Raw median overall survival (OS) was 23.1 months (95%CI[14.6-27.8]) in the PTR group and 22.1 months (95%CI[12.3-23.7]) in the non-PTR group (p = 0.11). After adjustment on IPTW, OS was 23.1 months (95%CI[17.0-28.7]) in the PTR group and 17.2 months (95%CI[13.5-22.2]) in the non-PTR group (HR 0.68; 95%CI[0.50-0.93]; p = 0.016). This result remained significant on multivariate analysis (HR 0.71; 95%CI[0.50-1.00]; p = 0.05). CONCLUSION: In mCC patients with unresectable metastases receiving chemotherapy, up-front PTR was independently associated with prolonged OS. Patients eligible for secondary metastases resection and/or bevacizumab may benefit the most from PTR. Randomized controlled trials are mandatory.
AIM: To explore the survival impact of primary tumor resection (PTR) in patients with metastatic colon cancer (mCC) and unresectable metastases. METHODS: We retrospectively studied a multicenter cohort of consecutive mCC patients with unresectable metastases receiving first-line chemotherapy. A weighted Cox proportional regression model was used to balance for clinical variables associated with the probability of undergoing PTR, using inverse probability of treatment weighting (IPTW) based on a propensity score. RESULTS: Ninety-six patients were included. PTR was performed in 69 (72%). The rates of secondary resection of metastases (p = 0.02) and bevacizumab administration (p = 0.02) were higher in the PTR group. Raw median overall survival (OS) was 23.1 months (95%CI[14.6-27.8]) in the PTR group and 22.1 months (95%CI[12.3-23.7]) in the non-PTR group (p = 0.11). After adjustment on IPTW, OS was 23.1 months (95%CI[17.0-28.7]) in the PTR group and 17.2 months (95%CI[13.5-22.2]) in the non-PTR group (HR 0.68; 95%CI[0.50-0.93]; p = 0.016). This result remained significant on multivariate analysis (HR 0.71; 95%CI[0.50-1.00]; p = 0.05). CONCLUSION: In mCC patients with unresectable metastases receiving chemotherapy, up-front PTR was independently associated with prolonged OS. Patients eligible for secondary metastases resection and/or bevacizumab may benefit the most from PTR. Randomized controlled trials are mandatory.
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