Palliative resection of the primary tumor is associated with improved overall survival in incurable stage IV colorectal cancer: A nationwide population‐based propensity‐score adjusted study in the Netherlands

As the value of palliative primary tumor resection in stage IV colorectal cancer (CRC) is still under debate, the purpose of this population‐based study was to investigate if palliative primary tumor resection as the initial treatment after diagnosis was associated with improved overall survival. Al...

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Bibliographic Details
Published in:International journal of cancer 2016-11, Vol.139 (9), p.2082-2094
Main Authors: 't Lam‐Boer, Jorine, Van der Geest, Lydia G., Verhoef, Cees, Elferink, Marloes E., Koopman, Miriam, de Wilt, Johannes H.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Cancer
Cancer surgery
Colorectal cancer
Colorectal Neoplasms - mortality
Colorectal Neoplasms - surgery
Female
Humans
Male
Medical research
metastatic colorectal cancer
Middle Aged
Mortality
Neoplasm Staging
Netherlands
Palliative Care - methods
palliative primary tumor resection
Propensity Score
Proportional Hazards Models
Registries
Surgical outcomes
Survival Analysis
systemic therapy
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Summary:As the value of palliative primary tumor resection in stage IV colorectal cancer (CRC) is still under debate, the purpose of this population‐based study was to investigate if palliative primary tumor resection as the initial treatment after diagnosis was associated with improved overall survival. All patients with stage IV colorectal adenocarcinoma (2008–2011) were selected from the Netherlands Cancer Registry, and patients undergoing treatment with curative intent (i.e., metastasectomy, radiofrequency ablation and/or hyperthermic intraperitoneal chemotherapy), or best supportive care were excluded. After propensity score matching, a multivariable Cox proportional hazard model was performed to determine the association between treatment strategy and mortality. From a total group of 10,371 patients with stage IV CRC, 2,746 patients (26%) underwent an elective palliative resection of the primary tumor, whether or not followed by systemic therapy, and 3,345 patients (32%) were initially treated with palliative systemic therapy. After propensity score matching, median overall survival in these groups was 17.2 months (95% CI 16.3–18.1) and 11.5 months (95% CI 11.0–12.0), respectively. In Cox regression analysis, primary tumor resection was significantly associated with improved overall survival (hazard ratio of death = 0.44 [95% CI 0.35–0.55], p 
ISSN:0020-7136
1097-0215
DOI:10.1002/ijc.30240