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International Journal of Colorectal Disease

, Volume 30, Issue 6, pp 807–812 | Cite as

Benefit of primary tumor resection in stage IV colorectal cancer with unresectable metastasis: a multicenter retrospective study using a propensity score analysis

  • Soichiro Ishihara
  • Takeshi Nishikawa
  • Toshiaki Tanaka
  • Junichiro Tanaka
  • Tomomichi Kiyomatsu
  • Kazushige Kawai
  • Keisuke Hata
  • Hioaki Nozawa
  • Shinsuke Kazama
  • Hironori Yamaguchi
  • Eiji Sunami
  • Joji Kitayama
  • Kenichi Sugihara
  • Toshiaki WatanabeEmail author
Original Article

Abstract

Purpose

Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer (CRC) with unresectable metastasis (mCRC). The aim of this study was to investigate the prognostic impact of primary tumor resection in various subgroups of mCRC patients.

Methods

A total of 1982 patients with mCRC from January 1997 to December 2007 were retrospectively evaluated. The impact of primary tumor resection on cancer-specific survival (CSS) was analyzed using propensity score analysis to mitigate selection bias. Covariates in the models for propensity scores included treatment period, age, gender, tumor location, depth, lymph node metastasis, number of metastatic organs, and carcinoembryonic antigen (CEA) levels.

Results

Among the whole patient population, primary tumor resection significantly improved CSS [hazard ratio (HR) 0.46, 95 % confidence interval (CI) 0.32–0.66, p < 0.01]. However, primary tumor resection did not significantly improve CSS in the following subgroups: patients treated in the first 5 years of the study (HR 0.56, 95 % CI 0.28–1.13, p = 0.08), patients aged >65 years (HR 0.72, 95 % CI 0.36–1.42, p = 0.31), female patients (HR 0.60, 95 % CI 0.31–1.17, p = 0.13), patients with right-sided colon cancer (HR 0.68, 95 % CI 0.39–1.20, p = 0.17), and patients without nodal involvement (HR 0.54, 95 % CI 0.25–1.17, p = 0.09).

Conclusions

Our study suggests that primary tumor resection improves the survival of patients with mCRC. However, the prognostic benefit is different among patient subpopulations.

Keywords

Colorectal cancer Stage IV Primary tumor resection Propensity score analysis 

Notes

Acknowledgments

The authors completed this study in collaboration with the following: K. Hirata (Sapporo Medical University), A. Murata (Hirosaki University), K. Hatakeyama (Niigata University), K. Hase (National Defense Medical College), K. Kotake (Tochigi Cancer Center), T. Watanabe (University of Tokyo), T. Masaki (Kyorin University), S. Kameoka (Tokyo Women’s Medical University), H. Hasegawa (Keio University), K. Takahashi (Tokyo Metropolitan Cancer and Infectious Diseases Center), H. Yano (International Medical Center of Japan), K. Sugihara (Tokyo Medical and Dental University), Y. Hashiguchi (Teikyo University), K. Maeda (Fujita Health University), K. Komori (Aichi Cancer Center), Y. Sakai (Kyoto University), and K. Shirouzu (Kurume University).

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Soichiro Ishihara
    • 1
  • Takeshi Nishikawa
    • 1
  • Toshiaki Tanaka
    • 1
  • Junichiro Tanaka
    • 1
  • Tomomichi Kiyomatsu
    • 1
  • Kazushige Kawai
    • 1
  • Keisuke Hata
    • 1
  • Hioaki Nozawa
    • 1
  • Shinsuke Kazama
    • 1
  • Hironori Yamaguchi
    • 1
  • Eiji Sunami
    • 1
  • Joji Kitayama
    • 1
  • Kenichi Sugihara
    • 2
  • Toshiaki Watanabe
    • 1
    Email author
  1. 1.Department of Surgical OncologyThe University of Tokyo HospitalTokyoJapan
  2. 2.Department of Surgical OncologyTokyo Medical and Dental UniversityTokyoJapan

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