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

31 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 Sep
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Oncology

Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

  • Cite this

    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, 21(9), 2949-2955. https://doi.org/10.1245/s10434-014-3719-1