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. 2021 Apr;37(2):94-100.
doi: 10.3393/ac.2020.09.15.1. Epub 2021 Apr 30.

The Impact of Primary Tumor Resection on Survival in Asymptomatic Colorectal Cancer Patients With Unresectable Metastases

Ki Yoon Doah  1 , Ui Sup Shin  1 , Byong Ho Jeon  1 , Sang Sik Cho  1 , Sun Mi Moon  1
Affiliations

The Impact of Primary Tumor Resection on Survival in Asymptomatic Colorectal Cancer Patients With Unresectable Metastases

Ki Yoon Doah et al. Ann Coloproctol. 2021 Apr.

Abstract

Purpose: This study was conducted to evaluate the effectiveness of primary tumor resection (PTR) in asymptomatic colorectal cancer (CRC) patients with unresectable metastases using the inverse probability of treatment weighting (IPTW) method to minimize selection bias.

Methods: We selected 146 patients diagnosed with stage IV CRC with unresectable metastasis between 2001 and 2018 from our institutional database. In a multivariate logistic regression model using the patients' baseline covariates associated with PTR, we applied the IPTW method based on a propensity score and performed a weighted Cox proportional regression analysis to estimate survival according to PTR.

Results: Upfront PTR was performed in 98 patients, and no significant differences in baseline factors were detected. The upweighted median survival of the PTR group was 18 months and that of the non-PTR group was 15 months (P = 0.15). After applying the IPTW, the PTR was still insignificant in the univariate Cox regression (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.5-1.21). However, in the multivariate weighted Cox regression with adjustment for other covariates, the PTR showed a significantly decreased risk of cancer-related death (HR, 0.61; 95% CI, 0.40-0.94).

Conclusion: In this study, we showed that asymptomatic CRC patients with unresectable metastases could gain a survival benefit from upfront PTR by analysis with the IPTW method. However, randomized controlled trials are mandatory.

Keywords: Colonic neoplasms; Neoplasm metastasis; Probability; Prognosis; Selection bias; Surgery.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Standardized mean difference (SMD) of baseline covariates before and after inverse probability treatment weighting. CEA, carcinoembryonic antigen.
Fig. 2.
Fig. 2.
Estimated survival of primary tumor resection (PTR) and non-PTR group by weighted multivariate Cox regression.
See this image and copyright information in PMC

Comment in

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