Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis: A propensity score analysis in a multicenter retrospective study

Soichiro Ishihara, Tamuro Hayama, Hideki Yamada, Keijiro Nozawa, Keiji Matsuda, Hiroaki Miyata, Satomi Yoneyama, Toshiaki Tanaka, Junichiro Tanaka, Tomomichi Kiyomatsu, Kazushige Kawai, Hioaki Nozawa, Takamitsu Kanazawa, Shinsuke Kazama, Hironori Yamaguchi, Eiji Sunami, Joji Kitayama, Yojiro Hashiguchi, Kenichi Sugihara, Toshiaki Watanabe

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background. Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer with unresectable metastasis (mCRC). Prognostic significance of lymph node dissection (LND) in mCRC has not been examined previously. The aim of this study was to investigate the prognostic impact of primary tumor resection and LND in mCRC. Methods. A total of 1,982 patients with mCRC from January 1997 to December 2007 were retrospectively studied. The impact of primary tumor resection and LND on overall survival (OS) was analyzed using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Covariates in the models for propensity scores included treatment period, institution, age, sex, carcinoembryonic antigen, tumor location, histology, depth, lymph node metastasis, lymphovascular invasion, and number of metastatic organs. Results. In a multivariate analysis, primary tumor resection and treatment in the latter period were associated with an improved OS, and age over 70 years, female sex, lymph node metastasis, and multiple organ metastasis were associated with a decreased OS. In the propensity-matched cohort, patients treated with primary tumor resection showed a significantly better OS than those without tumor resection (median OS 13.8 vs. 6.3 months; p = 0.0001). Furthermore, among patients treated with primary tumor resection, patients treated with D3 LND showed a significantly better OS than those with less extensive LND (median OS 17.2 vs. 13.7 months; p < 0.0001). Conclusions. It was suggested that primary tumor resection with D3 LND improves the survival of patients with mCRC.

Original languageEnglish
Pages (from-to)2949-2955
Number of pages7
JournalAnnals of Surgical Oncology
Volume21
Issue number9
DOIs
Publication statusPublished - 2014
Externally publishedYes

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Propensity Score
Lymph Node Excision
Multicenter Studies
Colorectal Neoplasms
Retrospective Studies
Neoplasm Metastasis
Survival
Neoplasms
Lymph Nodes
Selection Bias
Carcinoembryonic Antigen
Proportional Hazards Models
Histology
Multivariate Analysis

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis : A propensity score analysis in a multicenter retrospective study. / Ishihara, Soichiro; Hayama, Tamuro; Yamada, Hideki; Nozawa, Keijiro; Matsuda, Keiji; Miyata, Hiroaki; Yoneyama, Satomi; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Kawai, Kazushige; Nozawa, Hioaki; Kanazawa, Takamitsu; Kazama, Shinsuke; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji; Hashiguchi, Yojiro; Sugihara, Kenichi; Watanabe, Toshiaki.

In: Annals of Surgical Oncology, Vol. 21, No. 9, 2014, p. 2949-2955.

Research output: Contribution to journalArticle

Ishihara, S, Hayama, T, Yamada, H, Nozawa, K, Matsuda, K, Miyata, H, Yoneyama, S, Tanaka, T, Tanaka, J, Kiyomatsu, T, Kawai, K, Nozawa, H, Kanazawa, T, Kazama, S, Yamaguchi, H, Sunami, E, Kitayama, J, Hashiguchi, Y, Sugihara, K & Watanabe, T 2014, 'Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis: A propensity score analysis in a multicenter retrospective study', Annals of Surgical Oncology, vol. 21, no. 9, pp. 2949-2955. https://doi.org/10.1245/s10434-014-3719-1
Ishihara, Soichiro ; Hayama, Tamuro ; Yamada, Hideki ; Nozawa, Keijiro ; Matsuda, Keiji ; Miyata, Hiroaki ; Yoneyama, Satomi ; Tanaka, Toshiaki ; Tanaka, Junichiro ; Kiyomatsu, Tomomichi ; Kawai, Kazushige ; Nozawa, Hioaki ; Kanazawa, Takamitsu ; Kazama, Shinsuke ; Yamaguchi, Hironori ; Sunami, Eiji ; Kitayama, Joji ; Hashiguchi, Yojiro ; Sugihara, Kenichi ; Watanabe, Toshiaki. / Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis : A propensity score analysis in a multicenter retrospective study. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 9. pp. 2949-2955.
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abstract = "Background. Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer with unresectable metastasis (mCRC). Prognostic significance of lymph node dissection (LND) in mCRC has not been examined previously. The aim of this study was to investigate the prognostic impact of primary tumor resection and LND in mCRC. Methods. A total of 1,982 patients with mCRC from January 1997 to December 2007 were retrospectively studied. The impact of primary tumor resection and LND on overall survival (OS) was analyzed using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Covariates in the models for propensity scores included treatment period, institution, age, sex, carcinoembryonic antigen, tumor location, histology, depth, lymph node metastasis, lymphovascular invasion, and number of metastatic organs. Results. In a multivariate analysis, primary tumor resection and treatment in the latter period were associated with an improved OS, and age over 70 years, female sex, lymph node metastasis, and multiple organ metastasis were associated with a decreased OS. In the propensity-matched cohort, patients treated with primary tumor resection showed a significantly better OS than those without tumor resection (median OS 13.8 vs. 6.3 months; p = 0.0001). Furthermore, among patients treated with primary tumor resection, patients treated with D3 LND showed a significantly better OS than those with less extensive LND (median OS 17.2 vs. 13.7 months; p < 0.0001). Conclusions. It was suggested that primary tumor resection with D3 LND improves the survival of patients with mCRC.",
author = "Soichiro Ishihara and Tamuro Hayama and Hideki Yamada and Keijiro Nozawa and Keiji Matsuda and Hiroaki Miyata and Satomi Yoneyama and Toshiaki Tanaka and Junichiro Tanaka and Tomomichi Kiyomatsu and Kazushige Kawai and Hioaki Nozawa and Takamitsu Kanazawa and Shinsuke Kazama and Hironori Yamaguchi and Eiji Sunami and Joji Kitayama and Yojiro Hashiguchi and Kenichi Sugihara and Toshiaki Watanabe",
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TY - JOUR

T1 - Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis

T2 - A propensity score analysis in a multicenter retrospective study

AU - Ishihara, Soichiro

AU - Hayama, Tamuro

AU - Yamada, Hideki

AU - Nozawa, Keijiro

AU - Matsuda, Keiji

AU - Miyata, Hiroaki

AU - Yoneyama, Satomi

AU - Tanaka, Toshiaki

AU - Tanaka, Junichiro

AU - Kiyomatsu, Tomomichi

AU - Kawai, Kazushige

AU - Nozawa, Hioaki

AU - Kanazawa, Takamitsu

AU - Kazama, Shinsuke

AU - Yamaguchi, Hironori

AU - Sunami, Eiji

AU - Kitayama, Joji

AU - Hashiguchi, Yojiro

AU - Sugihara, Kenichi

AU - Watanabe, Toshiaki

PY - 2014

Y1 - 2014

N2 - Background. Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer with unresectable metastasis (mCRC). Prognostic significance of lymph node dissection (LND) in mCRC has not been examined previously. The aim of this study was to investigate the prognostic impact of primary tumor resection and LND in mCRC. Methods. A total of 1,982 patients with mCRC from January 1997 to December 2007 were retrospectively studied. The impact of primary tumor resection and LND on overall survival (OS) was analyzed using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Covariates in the models for propensity scores included treatment period, institution, age, sex, carcinoembryonic antigen, tumor location, histology, depth, lymph node metastasis, lymphovascular invasion, and number of metastatic organs. Results. In a multivariate analysis, primary tumor resection and treatment in the latter period were associated with an improved OS, and age over 70 years, female sex, lymph node metastasis, and multiple organ metastasis were associated with a decreased OS. In the propensity-matched cohort, patients treated with primary tumor resection showed a significantly better OS than those without tumor resection (median OS 13.8 vs. 6.3 months; p = 0.0001). Furthermore, among patients treated with primary tumor resection, patients treated with D3 LND showed a significantly better OS than those with less extensive LND (median OS 17.2 vs. 13.7 months; p < 0.0001). Conclusions. It was suggested that primary tumor resection with D3 LND improves the survival of patients with mCRC.

AB - Background. Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer with unresectable metastasis (mCRC). Prognostic significance of lymph node dissection (LND) in mCRC has not been examined previously. The aim of this study was to investigate the prognostic impact of primary tumor resection and LND in mCRC. Methods. A total of 1,982 patients with mCRC from January 1997 to December 2007 were retrospectively studied. The impact of primary tumor resection and LND on overall survival (OS) was analyzed using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Covariates in the models for propensity scores included treatment period, institution, age, sex, carcinoembryonic antigen, tumor location, histology, depth, lymph node metastasis, lymphovascular invasion, and number of metastatic organs. Results. In a multivariate analysis, primary tumor resection and treatment in the latter period were associated with an improved OS, and age over 70 years, female sex, lymph node metastasis, and multiple organ metastasis were associated with a decreased OS. In the propensity-matched cohort, patients treated with primary tumor resection showed a significantly better OS than those without tumor resection (median OS 13.8 vs. 6.3 months; p = 0.0001). Furthermore, among patients treated with primary tumor resection, patients treated with D3 LND showed a significantly better OS than those with less extensive LND (median OS 17.2 vs. 13.7 months; p < 0.0001). Conclusions. It was suggested that primary tumor resection with D3 LND improves the survival of patients with mCRC.

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JO - Annals of Surgical Oncology

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