Key result
Surgical resection of primary and metastatic sites is linked to ~24% higher absolute 5-year survival.
Why the study?
While multimodality therapy is considered the standard of care for metastatic colorectal cancer, the impact of perioperative therapy on surgical resection needed evaluation.
Does perioperative therapy and surgical resection improve survival in patients with metastatic colorectal cancer?
Observational (n=61,940)
Yes
Does perioperative therapy and surgical resection improve survival in patients with metastatic colorectal cancer?
Absolute Event Rate: 28.2% vs 4.7%
Perioperative therapy and surgical resection of primary and metastatic sites are associated with improved survival in patients with metastatic colorectal cancer.
This is the authors' abstract. We don't add key points for this paper.
BACKGROUND: Multimodality therapy of metastatic colorectal cancer (mCRC) is currently considered the standard of care. The aim of this study was to evaluate the impact of perioperative therapy on surgical resection in mCRC. METHODS: The National Cancer Database was analyzed for affected patients between 2004 and 2013. Univariate and multivariate analyses were done to identify factors associated with patient outcomes. Kaplan-Meier analysis and Cox proportional hazards models were used for the association between patient characteristics and survival. RESULTS: About 61,940 patients with mCRC were identified. Mean age = 63.4 years (SD ± 14). About 69% had a colon primary and 32% had only one metastatic site. Only 49% of those who underwent surgery for both primary and metastatic sites received postoperative chemotherapy (p < .001). Negative prognostic factors included no chemotherapy received (hazard ratio [HR], 2.32; 2.27-2.37; p < .001), more than three metastatic sites (HR, 2.28; 2.09-2.48; p < .001), year of diagnosis between 2004 and 2008 (HR, 1.71; 1.15-1.20; p < .001) and colon tumor location with right worse than left-sided (HR, 1.21; 1.19-1.24; p < .001). Five-year overall survival for resection of the primary and metastatic site (28.2%) was higher than for no surgical treatment (4.7%). CONCLUSION: Perioperative therapy was associated with improved survival, following resection of metastatic sites or primary tumor.
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Resection plus chemotherapy was associated with better survival in metastatic colorectal cancer; leaves open need for randomized confirmation before practice change.
Alese et al. (2020) conducted an observational in Metastatic colorectal cancer (n=61,940). Surgical resection of primary and metastatic sites vs. No surgical treatment was evaluated on 5-year overall survival. Surgical resection of primary and metastatic sites yielded 28.2% 5-year overall survival vs 4.7% without surgery; omitting chemotherapy worsened survival (HR 2.32; 95% CI 2.27-2.37; P<0.001).
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