Primary Tumor Resection in Patients Presenting With Metastatic Colorectal Cancer Analysis of a Provincial Population-Based Cohort

被引:22
作者
Chan, Theresa W. [1 ]
Brown, Carl [2 ]
Ho, Cheryl C. [1 ]
Gill, Sharlene [1 ]
机构
[1] British Columbia Canc Agcy, Div Med Oncol, Vancouver, BC V5Z 4E6, Canada
[2] St Pauls Hosp, Dept Surg, Vancouver, BC V6Z 1Y6, Canada
来源
AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS | 2010年 / 33卷 / 01期
关键词
primary resection; metastatic colorectal cancer; FLUOROURACIL; LEUCOVORIN; SURVIVAL; OXALIPLATIN; COMBINATION; BEVACIZUMAB; IRINOTECAN; SURGERY; DISEASE;
D O I
10.1097/COC.0b013e31819e902d
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: We conducted a Canadian population-based study to assess surgical practice patterns and outcomes among patients with metastatic colorectal cancer (mCRC) at diagnosis. Methods: We reviewed a provincial cancer registry for 2 years. Four hundred eleven patients presenting with mCRC were stratified by primary tumor resection Status. Baseline characteristics, treatment modalities, and outcomes were assessed. Results: Seventy percent of patients underwent resection. Resected patients were less likely to have rectal primaries (16% vs. 42%, P <= 0.001) and had more obstructive symptoms (47% vs. 31%, P <= 0.001) or bleeding (26% vs. 6%. P <= 0.001). They experienced fewer tumor-related complications (4% vs. 22%, P <= 0.001). Use of first-line chemotherapy was similar (61%, vs. 58%, P = 0.54). but the resection cohort was more likely to receive doublet chemotherapy (57% vs. 36%, P <= 0.01) and metastatectomy (10% vs. 0%, P <= 0.0001). Among patients with rectal tumors, radiation use was comparable (63% vs 58%, P = 0.68). Median survival was longer in the resection group (14 vs. 6 months, P <= 0.001). Conclusions: Most patients presenting with mCRC underwent primary resection. Colonic tumors, obstruction, and bleeding were associated with resection. In situ primaries conferred more complications. despite similar use of radiation in cases of rectal cancer. Unresected patients were less likely to receive doublet chemotherapy or metastatectomy, and had inferior survival.
引用
收藏
页码:52 / 55
页数:4
相关论文
共 18 条
[1]   Treatment strategy for patients with colorectal cancer and synchronous irresectable liver metastases [J].
Benoist, S ;
Pautrat, K ;
Mitry, E ;
Rougier, P ;
Penna, C ;
Nordlinger, B .
BRITISH JOURNAL OF SURGERY, 2005, 92 (09) :1155-1160
[2]   Surgical resection of primary tumors in patients who present with stage IV colorectal cancer: An analysis of surveillance, epidemiology, and end results data, 1988 to 2000 [J].
Cook, AD ;
Single, R ;
McCahill, LE .
ANNALS OF SURGICAL ONCOLOGY, 2005, 12 (08) :637-645
[3]   Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer [J].
de Gramont, A ;
Figer, A ;
Seymour, M ;
Homerin, M ;
Hmissi, A ;
Cassidy, J ;
Boni, C ;
Cortes-Funes, H ;
Cervantes, A ;
Freyer, G ;
Papamichael, D ;
Le Bail, N ;
Louvet, C ;
Hendler, D ;
de Braud, F ;
Wilson, C ;
Morvan, F ;
Bonetti, A .
JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (16) :2938-2947
[4]   Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer [J].
Flanigan, RC ;
Salmon, SE ;
Blumenstein, BA ;
Bearman, SI ;
Roy, V ;
McGrath, PC ;
Caton, JR ;
Munshi, N ;
Crawford, ED .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (23) :1655-1659
[5]   Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: Results from the Eastern Cooperative Oncology Group Study E3200 [J].
Giantonio, Bruce J. ;
Catalano, Paul J. ;
Meropol, Neal J. ;
O'Dwyer, Peter J. ;
Mitchell, Edith P. ;
Alberts, Steven R. ;
Schwartz, Michael A. ;
Benson, Al B., III .
JOURNAL OF CLINICAL ONCOLOGY, 2007, 25 (12) :1539-1544
[6]   THE EFFECT OF DIAMETER OF LARGEST RESIDUAL DISEASE ON SURVIVAL AFTER PRIMARY CYTOREDUCTIVE SURGERY IN PATIENTS WITH SUBOPTIMAL RESIDUAL EPITHELIAL OVARIAN-CARCINOMA [J].
HOSKINS, WJ ;
MCGUIRE, WP ;
BRADY, MF ;
HOMESLEY, HD ;
CREASMAN, WT ;
BERMAN, M ;
BALL, H ;
BEREK, JS .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1994, 170 (04) :974-980
[7]   Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer [J].
Hurwitz, H ;
Fehrenbacher, L ;
Novotny, W ;
Cartwright, T ;
Hainsworth, J ;
Heim, W ;
Berlin, J ;
Baron, A ;
Griffing, S ;
Holmgren, E ;
Ferrara, N ;
Fyfe, G ;
Rogers, B ;
Ross, R ;
Kabbinavar, F .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (23) :2335-2342
[8]   Bevacizurnab in combination with fluorouracil and leucovorin: An active regimen for first-line metastatic colorectal cancer [J].
Hurwitz, HI ;
Fehrenbacher, L ;
Hainsworth, JD ;
Heim, W ;
Berlin, J ;
Holmgren, E ;
Hambleton, J ;
Novotny, WF ;
Kabbinavar, F .
JOURNAL OF CLINICAL ONCOLOGY, 2005, 23 (15) :3502-3508
[9]   Influence of palliative surgical resection on overall survival in patients with advanced colorectal cancer: a retrospective single institutional study [J].
Kaufman, M. S. ;
Radhakrishnan, N. ;
Roy, R. ;
Gecelter, G. ;
Tsang, J. ;
Thomas, A. ;
Nissel-Horowitz, S. ;
Mehrotra, B. .
COLORECTAL DISEASE, 2008, 10 (05) :498-502
[10]   Outcomes of resection of stage IV rectal cancer with mesorectal excision [J].
Law, WL ;
Chu, KW .
JOURNAL OF SURGICAL ONCOLOGY, 2006, 93 (07) :523-528