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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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

The authors completed this study in collaboration with the following: K. Hirata (Sapproro Medical University), A. Murata (Hirosaki University), K. Hatakeyama (Niigata University), K. Hase (National Defense Medical College), K. Kotake (Tochighi 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 Disease 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).

Conflicts of Interest and Sources of Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan

    Soichiro Ishihara MD, PhD, Satomi Yoneyama MD, PhD, Toshiaki Tanaka MD, PhD, Junichiro Tanaka MD, PhD, Tomomichi Kiyomatsu MD, PhD, Kazushige Kawai MD, PhD, Hioaki Nozawa MD, PhD, Takamitsu Kanazawa MD, PhD, Shinsuke Kazama MD, PhD, Hironori Yamaguchi MD, PhD, Eiji Sunami MD, PhD, Joji Kitayama MD, PhD & Toshiaki Watanabe MD, PhD

  2. Department of Surgery, Teikyo University, Tokyo, Japan

    Tamuro Hayama MD, PhD, Hideki Yamada MD, PhD, Keijiro Nozawa MD, PhD, Keiji Matsuda MD, PhD & Yojiro Hashiguchi MD, PhD

  3. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hiroaki Miyata PhD

  4. Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara MD, PhD

Authors
  1. Soichiro Ishihara MD, PhD
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  2. Tamuro Hayama MD, PhD
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  3. Hideki Yamada MD, PhD
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  4. Keijiro Nozawa MD, PhD
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  5. Keiji Matsuda MD, PhD
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  6. Hiroaki Miyata PhD
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  7. Satomi Yoneyama MD, PhD
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  8. Toshiaki Tanaka MD, PhD
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  9. Junichiro Tanaka MD, PhD
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  10. Tomomichi Kiyomatsu MD, PhD
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  11. Kazushige Kawai MD, PhD
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  12. Hioaki Nozawa MD, PhD
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  13. Takamitsu Kanazawa MD, PhD
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  14. Shinsuke Kazama MD, PhD
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  15. Hironori Yamaguchi MD, PhD
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  16. Eiji Sunami MD, PhD
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  17. Joji Kitayama MD, PhD
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  18. Yojiro Hashiguchi MD, PhD
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  19. Kenichi Sugihara MD, PhD
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  20. Toshiaki Watanabe MD, PhD
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Corresponding author

Correspondence to Toshiaki Watanabe MD, PhD.

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Ishihara, S., Hayama, T., Yamada, H. et al. 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. Ann Surg Oncol 21, 2949–2955 (2014). https://doi.org/10.1245/s10434-014-3719-1

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  • DOI: https://doi.org/10.1245/s10434-014-3719-1

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