Summary
BACKGROUND: The aim of the study was to evaluate prognostic factors and survival improvements in stage IV colorectal cancer patients who had all undergone resection of their primary tumor. METHODS: Between 1982 and 2006, 639 consecutive patients with UICC stage IV colorectal cancer underwent tumor resection followed by chemotherapy. Clinical, surgical, histopathological, and follow-up data were investigated and correlated with survival. RESULTS: Total R0 status was achieved in 101 patients (16%), and 128 patients (20%) underwent multivisceral resection. Median cause-specific survival for total R0 resected patients was 41 (95% CI: 32–50) months. The median cause-specific survival increased continuously from 10 (95% CI: 8–12) months for patients treated in the first years to 23 (95% CI: 19–27) months for those treated in the last 5 years of the study period. Multivariable analysis identified patients' age, pN, cM1a/b, R status, and the date of resection of the primary tumor as independent prognostic factors. CONCLUSIONS: Prognosis of stage IV colorectal cancer improved continuously in the last decades. Despite the ongoing discussion if the primary tumors should be resected in stage IV disease, prognostic factors can help to select M1 patients with potential long-term survival, who should undergo resection of the primary tumors and metastases followed by chemotherapy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Colon and Rectal Cancer. 2010 [cited 2010]; Available from: www.cancer.gov
Stewart SL, et al. A population-based study of colorectal cancer histology in the United States, 1998–2001. Cancer 2006;107(5 Suppl):1128–41
Kleespies A, Füessl KE, Seeliger H, et al. Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer. Int J Colorectal Dis 2009;24:1097–109
Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer. N Engl J Med 2005;352:476–87
Kopetz S, Chang GJ, Overman MJ, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 2009;27:3677–83
Schmiegel W, Reinacher-Schick A, Arnold D, et al. Update S3-guideline "colorectal cancer" 2008. Z Gastroenterol 2008;46:799–840
Scheer MG, Sloots CE, van der Wilt GJ, et al. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. Ann Oncol 2008;19:1829–35
Damjanov N, Weiss J, Haller DG. Resection of the primary colorectal cancer is not necessary in nonobstructed patients with metastatic disease. Oncologist 2009;14:963–9
Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 2009;27:3379–84
Hopt UT, Drognitz O, Neeff H. Timing of resection in patients with colorectal carcinoma and synchronous liver metastases. Zentralbl Chir 2009;134:425–9
Reddy SK, Barbas AS, Clary BM. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol 2009;16:2395–410
van der Pool AE, de Wilt JH, Lalmahomed ZS, et al. Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. Br J Surg 2010;97:383–90
Konyalian VR, Rosing DK, Haukoos JS, et al. The role of primary tumour resection in patients with stage IV colorectal cancer. Colorectal Dis 2007;9:430–7
Ruo L, Gougoutas C, Paty PB, et al. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg 2003;196:722–8
Mik M, Dziki L, Galbfach P, et al. Resection of the primary tumour or other palliative procedures in incurable IV stage colorectal cancer patients? Colorectal Dis 2010;12(7 Online):e61–7
Stillwell AP, Buettner PG, Ho YH. Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg 2010;34:797–807
Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 2007;25:4575–80
Cook AD, Single R, McCahill LE. Surgical resection of primary tumors in patients who present with stage IV colorectal cancer: an analysis of surveillance, epidemiology, and end results data, 1988 to 2000. Ann Surg Oncol 2005;12:637–45
Meulenbeld HJ, van Steenbergen LN, Janssen-Heijnen ML, et al. Significant improvement in survival of patients presenting with metastatic colon cancer in the south of The Netherlands from 1990 to 2004. Ann Oncol 2008;19:1600–4
Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of malignant tumors. West Sussex: Blackwell Publishing Ltd., 2010
Bajwa A, Blunt N, Vyas S, et al. Primary tumour resection and survival in the palliative management of metastatic colorectal cancer. Eur J Surg Oncol 2009;35:164–7
Stelzner S, Hellmich G, Koch R, et al. Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol 2005;89:211–7
Liu SK, Church JM, Lavery IC, et al. Operation in patients with incurable colon cancer – is it worthwhile? Dis Colon Rectum 1997;40:11–4
Aslam MI, Kelkar A, Sharpe D, et al. Ten years experience of managing the primary tumours in patients with stage IV colorectal cancers. Int J Surg 2010;8:305–13
Platell C, Ng S, O'bichere A, et al. Changing management and survival in patients with stage IV colorectal cancer. Dis Colon Rectum 2011;54:214–9
Scoggins CR, Campbell ML, Landry CS, et al. Preoperative chemotherapy does not increase morbidity or mortality of hepatic resection for colorectal cancer metastases. Ann Surg Oncol 2009;16:35–41
Costi R, Mazzeo A, Di Mauro D, et al. Palliative resection of colorectal cancer: does it prolong survival? Ann Surg Oncol 2007;14:2567–76
Beham A, Rentsch M, Püllmann K, et al. Survival benefit in patients after palliative resection vs. non-resection colon cancer surgery. World J Gastroenterol 2006;12:6634–8
Rosen SA, Buell JF, Yoshida A, et al. Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 2000;135:530–4; discussion 534–5
Author information
Authors and Affiliations
Corresponding author
Additional information
*U. Nitsche and M. Maak contributed equally to this work.
Rights and permissions
About this article
Cite this article
Nitsche, U., Maak, M., Künzli, B. et al. Prognostic factors and survival improvements in stage IV colorectal cancer* . Eur Surg 44, 47–53 (2012). https://doi.org/10.1007/s10353-011-0037-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10353-011-0037-8