Hidetaka Kawamura1,2,3, Yusuke Ogawa4, Hajime Yamazaki4,5, Michitaka Honda6,7, Koji Kono8, Shinichi Konno9, Shunichi Fukuhara4,5, Yosuke Yamamoto4. 1. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo, Kyoto, 606-8501, Japan. hidetaka0716.hk@gmail.com. 2. Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Koriyama, Japan. hidetaka0716.hk@gmail.com. 3. Department of Surgical Oncology, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan. hidetaka0716.hk@gmail.com. 4. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo, Kyoto, 606-8501, Japan. 5. Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 6. Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Koriyama, Japan. 7. Department of Surgical Oncology, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan. 8. Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Fukushima, Japan. 9. Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, Japan.
Abstract
BACKGROUND: Primary tumor resection (PTR) before commencing systemic chemotherapy in patients with stage IV colorectal cancer and unresectable metastases (mCRC) remains controversial. This study aimed to assess whether PTR before systemic chemotherapy is associated with mortality in mCRC patients, after adjusting for confounding factors, such as the severity of the primary tumor and metastatic lesions. METHODS: We analyzed hospital-based cancer registries from nine designated cancer hospitals in Fukushima Prefecture, Japan. Patients were divided into two groups (PTR and non-PTR), based on whether PTR was performed as initial therapy for mCRC or not. The primary outcome was all-cause mortality. Kaplan-Meier survival analysis was performed, and survival estimates were compared using the log-rank test. Adjusted hazard ratios were calculated using Cox regression to adjust for confounding factors. All tests were two-sided; P-values < 0.05 were considered statistically significant. RESULTS: Between 2008 and 2015, 616 mCRC patients were included (PTR: 414 [67.2%]; non-PTR: 202 [32.8%]). The median follow-up time was 18.0 (interquartile range [IQR]: 8.4-29.7) months, and 492 patients (79.9%) died during the study period. Median overall survival in the PTR and non-PTR groups was 23.9 (IQR: 12.2-39.9) and 12.3 (IQR: 6.2-23.8) months, respectively (P < 0.001, log-rank test). PTR was significantly associated with improved overall survival (adjusted hazard ratio: 0.51; 95% confidence interval: 0.42-0.64, P < 0.001). CONCLUSIONS: PTR before systemic chemotherapy in patients with mCRC was associated with improved survival.
BACKGROUND:Primary tumor resection (PTR) before commencing systemic chemotherapy in patients with stage IV colorectal cancer and unresectable metastases (mCRC) remains controversial. This study aimed to assess whether PTR before systemic chemotherapy is associated with mortality in mCRC patients, after adjusting for confounding factors, such as the severity of the primary tumor and metastatic lesions. METHODS: We analyzed hospital-based cancer registries from nine designated cancer hospitals in Fukushima Prefecture, Japan. Patients were divided into two groups (PTR and non-PTR), based on whether PTR was performed as initial therapy for mCRC or not. The primary outcome was all-cause mortality. Kaplan-Meier survival analysis was performed, and survival estimates were compared using the log-rank test. Adjusted hazard ratios were calculated using Cox regression to adjust for confounding factors. All tests were two-sided; P-values < 0.05 were considered statistically significant. RESULTS: Between 2008 and 2015, 616 mCRC patients were included (PTR: 414 [67.2%]; non-PTR: 202 [32.8%]). The median follow-up time was 18.0 (interquartile range [IQR]: 8.4-29.7) months, and 492 patients (79.9%) died during the study period. Median overall survival in the PTR and non-PTR groups was 23.9 (IQR: 12.2-39.9) and 12.3 (IQR: 6.2-23.8) months, respectively (P < 0.001, log-rank test). PTR was significantly associated with improved overall survival (adjusted hazard ratio: 0.51; 95% confidence interval: 0.42-0.64, P < 0.001). CONCLUSIONS: PTR before systemic chemotherapy in patients with mCRC was associated with improved survival.