Chi-Hao Zhang1, Yuan-Bo Pan2, Qing-Wei Zhang3, Ou-Min Shi4, Lei Zheng1, Liang Gui1, Meng Luo5. 1. Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China. 2. Department of Neurosurgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China. 3. Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China. 4. The Second Affiliated Hospital of Shenzhen University, Shenzhen, 518000, China. 5. Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, 200001, Shanghai, China. 1552888659@qq.com.
Abstract
PURPOSE: This study was aimed to determine the effect of the local tumor therapy on patients' prognosis in the management of metastatic rectal cancer. METHODS: Patients diagnosed with metastatic rectal cancer from 2004 to 2013 were selected from the SEER (Surveillance, Epidemiology, and End Results) database. Overall survival and cancer-specific survival were compared between the local treatment group and the nonlocal treatment group using Kaplan-Meier methods. Uni- and multivariate analyses were further performed to confirm or deny the results. The statistical approach of propensity score matching was conducted to avoid potential confounding factors. RESULTS: Of 6867 patients included in this analysis, 3971 (57.8%) received local therapy to the primary tumor and 2896 (42.2%) did not receive. Both univariable and multivariable analysis showed local therapy continued to be associated with an improvement in OS (HR 0.532; 95% CI 0.503-0.563, p < 0.001 and HR 0.532; 95% CI 0.498-0.568, p < 0.001, respectively) and CSS (HR 0.527; 95% CI 0.497-0.559, p < 0.001 and HR 0.521; 95% CI 0.487-0.557, p < 0.001, respectively) in the unmatched cohorts. Further analysis showed patients underwent local tumor destruction or surgical resection had a better overall survival compared with those who did not undergo (p < 0.001). In the matched population, patients receiving local therapy had a better OS (HR 0.427; 95% CI 0.428-0.519, p < 0.001) and CSS (HR 0.462; 95% CI 0.418-0.511, p < 0.001) compared with those who did not receive. CONCLUSIONS: Local therapy to the primary tumor may be associated with a better survival in patients with metastatic rectal cancer.
PURPOSE: This study was aimed to determine the effect of the local tumor therapy on patients' prognosis in the management of metastatic rectal cancer. METHODS:Patients diagnosed with metastatic rectal cancer from 2004 to 2013 were selected from the SEER (Surveillance, Epidemiology, and End Results) database. Overall survival and cancer-specific survival were compared between the local treatment group and the nonlocal treatment group using Kaplan-Meier methods. Uni- and multivariate analyses were further performed to confirm or deny the results. The statistical approach of propensity score matching was conducted to avoid potential confounding factors. RESULTS: Of 6867 patients included in this analysis, 3971 (57.8%) received local therapy to the primary tumor and 2896 (42.2%) did not receive. Both univariable and multivariable analysis showed local therapy continued to be associated with an improvement in OS (HR 0.532; 95% CI 0.503-0.563, p < 0.001 and HR 0.532; 95% CI 0.498-0.568, p < 0.001, respectively) and CSS (HR 0.527; 95% CI 0.497-0.559, p < 0.001 and HR 0.521; 95% CI 0.487-0.557, p < 0.001, respectively) in the unmatched cohorts. Further analysis showed patients underwent local tumor destruction or surgical resection had a better overall survival compared with those who did not undergo (p < 0.001). In the matched population, patients receiving local therapy had a better OS (HR 0.427; 95% CI 0.428-0.519, p < 0.001) and CSS (HR 0.462; 95% CI 0.418-0.511, p < 0.001) compared with those who did not receive. CONCLUSIONS: Local therapy to the primary tumor may be associated with a better survival in patients with metastatic rectal cancer.
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