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. 2023 Oct 19;15(20):5057.
doi: 10.3390/cancers15205057.

Clinical Outcomes of Upfront Primary Tumor Resection in Synchronous Unresectable Metastatic Colorectal Cancer

Ji Eun Shin  1 , Ho Jung An  1 , Byoung Yong Shim  1 , Hyunho Kim  1 , Hyung Soon Park  1 , Hyeon-Min Cho  2 , Bong-Hyeon Kye  2 , Ri Na Yoo  2 , Ji-Yeon Moon  2 , Sung Hwan Kim  3 , Jonghoon Lee  3 , Hyo Chun Lee  3 , Ji-Han Jung  4 , Kang-Moon Lee  5 , Ji Min Lee  5
Affiliations

Clinical Outcomes of Upfront Primary Tumor Resection in Synchronous Unresectable Metastatic Colorectal Cancer

Ji Eun Shin et al. Cancers (Basel). .

Abstract

The role of upfront primary tumor resection (PTR) in patients with unresectable metastatic colorectal cancer without severe symptoms remains controversial. We retrospectively analyzed the role of PTR in overall survival (OS) in this population. Among the 205 patients who enrolled, the PTR group (n = 42) showed better performance (p = 0.061), had higher frequencies of right-sided origin (p = 0.058), the T4 stage (p = 0.003), the M1a stage (p = 0.012), and <2 organ metastases (p = 0.002), and received fewer targeted agents (p = 0.011) than the chemotherapy group (n = 163). The PTR group showed a trend for longer OS (20.5 versus 16.0 months, p = 0.064) but was not related to OS in Cox regression multivariate analysis (p = 0.220). The male sex (p = 0.061), a good performance status (p = 0.078), the T3 stage (p = 0.060), the M1a stage (p = 0.042), <2 organ metastases (p = 0.035), an RAS wild tumor (p = 0.054), and the administration of targeted agents (p = 0.037), especially bevacizumab (p = 0.067), seemed to be related to PTR benefits. Upfront PTR could be considered beneficial in some subgroups, but these findings require larger studies to verify.

Keywords: asymptomatic; colorectal cancer; metastasis; primary tumor resection; synchronous.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection flowchart. CRC: colorectal cancer; PTR: primary tumor resection; CTx: chemotherapy.
Figure 2
Figure 2
A Kaplan–Meier curve of overall survival. PTR: primary tumor resection.
Figure 3
Figure 3
Forest plot of overall survival. PTR: primary tumor resection; ECOG: Eastern Cooperative Oncology Group; CEA: carcinoembryonic antigen; CI: confidence interval; HR: hazard ratio.
See this image and copyright information in PMC

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