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Systematic Review of Prognostic Factors Related to Overall Survival in Patients with Stage IV Colorectal Cancer and Unresectable Metastases

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Abstract

Background

With the improvements in newer chemotherapeutic agents, the role of primary tumour resection in patients with stage IV colorectal cancer is controversial. In many cases primary tumour resection is still favoured as first-line management. However, a detailed understanding of independent prognostic factors related to survival is necessary before making this decision.

Method

A literature search was conducted using Medline and Embase. Studies that performed multivariate analysis on overall survival of patients with incurable stage IV colorectal cancer were included in this review.

Results

Fourteen retrospective studies involving 3209 patients were included. Clinical variables analysed to consistently have independent prognostic significance for long-term survival included the patients’ performance status (<2), volume of liver metastases (<50%), nodal stage (N0), disease-free resection margins, and treatment with chemotherapy and/or primary tumour resection. Cancer antigen (CA) 19-9, low albumin, elevated ALP levels, apical lymph node involvement, presence of ascites, and postoperative transfusion were each assessed by only one study and found to be independently associated with survival. Factors inconsistently reported to have independent prognostic significance were age, ASA score, preoperative CEA levels, primary tumour location, tumour size and differentiation, peritoneal dissemination, and extrahepatic metastases.

Conclusion

Each patient should be reviewed individually on the basis of the above independent prognostic factors before deciding to resect the primary tumour. Patients with a poor performance status, extensive hepatic metastases, and extensive nodal disease detected preoperatively are less likely to have a survival benefit. Nonsurgical approaches to manage these patients should be given careful consideration.

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References

  1. Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics. 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  2. Cook AD, Single R, McCahill LE (2005) 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 12:637–645

    Article  PubMed  Google Scholar 

  3. Galizia G, Lieto E, Orditura M et al (2008) First-line chemotherapy vs bowel tumor resection plus chemotherapy for patients with unresectable synchronous colorectal hepatic metastases. Arch Surg 143:352–358

    Article  PubMed  Google Scholar 

  4. Nash GM, Saltz LB, Kemeny NE et al (2002) Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease. Ann Surg Oncol 9:954–960

    Article  PubMed  Google Scholar 

  5. Rosen SA, Buell JF, Yoshida A et al (2000) Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 135:530–534

    Article  CAS  PubMed  Google Scholar 

  6. Ruo L, Gougoutas C, Paty PB et al (2003) Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg 196:722–728

    Article  PubMed  Google Scholar 

  7. Stillwell AP, Buettner PG, Ho YH (2010) Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg 34:797–807

    Article  CAS  PubMed  Google Scholar 

  8. Michel P, Roque I, Di Fiore F et al (2004) Colorectal cancer with non-resectable synchronous metastases: should the primary tumor be resected? Gastroenterol Clin Biol 28:434–437

    Article  PubMed  Google Scholar 

  9. Muratore A, Zorzi D, Bouzari H et al (2007) Asymptomatic colorectal cancer with un-resectable liver metastases: immediate colorectal resection or up-front systemic chemotherapy? Ann Surg Oncol 14:766–770

    Article  PubMed  Google Scholar 

  10. Sarela AI, Guthrie JA, Seymour MT et al (2001) Non-operative management of the primary tumour in patients with incurable stage IV colorectal cancer. Br J Surg 88:1352–1356

    Article  CAS  PubMed  Google Scholar 

  11. Scoggins CR, Meszoely IM, Blanke CD et al (1999) Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol 6:651–657

    Article  CAS  PubMed  Google Scholar 

  12. Temple LK, Hsieh L, Wong WD et al (2004) Use of surgery among elderly patients with stage IV colorectal cancer. J Clin Oncol 22:3475–3484

    Article  PubMed  Google Scholar 

  13. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384

    Article  CAS  PubMed  Google Scholar 

  14. Dixon MR, Haukoos JS, Udani SM et al (2003) Carcinoembryonic antigen and albumin predict survival in patients with advanced colon and rectal cancer. Arch Surg 138:962–966

    Article  PubMed  Google Scholar 

  15. Liu SK, Church JM, Lavery IC et al (1997) Operation in patients with incurable colon cancer—is it worthwhile? Dis Colon Rectum 40:11–14

    Article  CAS  PubMed  Google Scholar 

  16. Scabini S, Rimini E, Romairone E et al (2010) Survival in surgical palliative resection of stage IV colorectal cancer: short term results in a single institution. Minerva Chir 65:17–20

    CAS  PubMed  Google Scholar 

  17. Scabini S, Rimini E, Romairone E et al (2009) Factors predicting survival in surgical palliative resection of stage IV colorectal cancer. Minerva Chir 64:303–306

    CAS  PubMed  Google Scholar 

  18. Cellini C, Hunt SR, Fleshman JW et al (2010) Stage IV rectal cancer with liver metastases: is there a benefit to resection of the primary tumor? World J Surg 34:1102–1108

    Article  PubMed  Google Scholar 

  19. Hotokezaka M, Jimi S, Hidaka H et al (2008) Factors influencing outcome after surgery for stage IV colorectal cancer. Surg Today 38:784–789

    Article  PubMed  Google Scholar 

  20. Law WL, Chu KW (2006) Outcomes of resection of stage IV rectal cancer with mesorectal excision. J Surg Oncol 93:523–528

    Article  PubMed  Google Scholar 

  21. Massacesi C, Norman A, Price T et al (2000) A clinical nomogram for predicting long-term survival in advanced colorectal cancer. Eur J Cancer 36:2044–2052

    Article  CAS  PubMed  Google Scholar 

  22. Gibbs J, Cull W, Henderson W et al (1999) Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg 134:36–42

    Article  CAS  PubMed  Google Scholar 

  23. Vibert E, Bretagnol F, Alves A et al (2007) Multivariate analysis of predictive factors for early postoperative death after colorectal surgery in patients with colorectal cancer and synchronous unresectable liver metastases. Dis Colon Rectum 50:1776–1782

    Article  PubMed  Google Scholar 

  24. Hotta T, Takifuji K, Uchiyama K et al (2006) Potential predictors of survival after surgery for colorectal cancer patients with synchronous unresectable liver metastases. Oncol Rep 16:1369–1374

    PubMed  Google Scholar 

  25. Stelzner S, Hellmich G, Koch R et al (2005) Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol 89:211–217

    Article  PubMed  Google Scholar 

  26. Tebbutt NC, Norman AR, Cunningham D et al (2003) Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases. Gut 52:568–573

    Article  CAS  PubMed  Google Scholar 

  27. Bajwa A, Blunt N, Vyas S et al (2009) Primary tumour resection and survival in the palliative management of metastatic colorectal cancer. Eur J Surg Oncol 35:164–167

    CAS  PubMed  Google Scholar 

  28. Aslam MI, Kelkar A, Sharpe D et al (2010) Ten years experience of managing the primary tumours in patients with stage IV colorectal cancers. Int J Surg 8(4):305–313

    Article  PubMed  Google Scholar 

  29. Katoh H, Yamashita K, Kokuba Y et al (2008) Surgical resection of stage IV colorectal cancer and prognosis. World J Surg 32:1130–1137

    Article  PubMed  Google Scholar 

  30. Kleespies A, Fuessl KE, Seeliger H et al (2009) Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer. Int J Colorectal Dis 24(9):1097–1109

    Article  PubMed  Google Scholar 

  31. Law WL, Chan WF, Lee YM et al (2004) Non-curative surgery for colorectal cancer: critical appraisal of outcomes. Int J Colorectal Dis 19:197–202

    Article  PubMed  Google Scholar 

  32. Mik M, Dziki L, Galbfach P et al (2010) Resection of the primary tumour or other palliative procedures in incurable IV stage colorectal cancer patients? Colorectal Dis 12(7 Online):e61–e67

    Google Scholar 

  33. Yamamura T, Tsukikawa S, Akaishi O et al (1997) Multivariate analysis of the prognostic factors of patients with unresectable synchronous liver metastases from colorectal cancer. Dis Colon Rectum 40:1425–1429

    Article  CAS  PubMed  Google Scholar 

  34. Harris GJ, Senagore AJ, Lavery IC et al (2002) Factors affecting survival after palliative resection of colorectal carcinoma. Colorectal Dis 4:31–35

    Article  PubMed  Google Scholar 

  35. Chafai N, Chan CL, Bokey EL et al (2005) What factors influence survival in patients with unresected synchronous liver metastases after resection of colorectal cancer? Colorectal Dis 7:176–181

    Article  CAS  PubMed  Google Scholar 

  36. Yun HR, Lee WY, Lee WS et al (2007) The prognostic factors of stage IV colorectal cancer and assessment of proper treatment according to the patient’s status. Int J Colorectal Dis 22:1301–1310

    Article  PubMed  Google Scholar 

  37. Poston GJ, Adam R, Alberts S et al (2005) OncoSurge: a strategy for improving resectability with curative intent in metastatic colorectal cancer. J Clin Oncol 23:7125–7134

    Article  PubMed  Google Scholar 

  38. Royston D, Jackson DG (2009) Mechanisms of lymphatic metastasis in human colorectal adenocarcinoma. J Pathol 217:608–619

    Article  CAS  PubMed  Google Scholar 

  39. Kaufman MS, Radhakrishnan N, Roy R et al (2008) Influence of palliative surgical resection on overall survival in patients with advanced colorectal cancer: a retrospective single institutional study. Colorectal Dis 10:498–502

    Article  CAS  PubMed  Google Scholar 

  40. van Hooft JE, Fockens P, Marinelli AW et al (2008) Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 40:184–191

    Article  PubMed  Google Scholar 

  41. Efficace F, Bottomley A, Coens C et al (2006) Does a patient’s self-reported health-related quality of life predict survival beyond key biomedical data in advanced colorectal cancer? Eur J Cancer 42:42–49

    Article  PubMed  Google Scholar 

  42. Lis CG, Gupta D, Granick J et al (2006) Can patient satisfaction with quality of life predict survival in advanced colorectal cancer? Support Care Cancer 14:1104–1110

    Article  PubMed  Google Scholar 

  43. Maisey NR, Norman A, Watson M et al (2002) Baseline quality of life predicts survival in patients with advanced colorectal cancer. Eur J Cancer 38:1351–1357

    Article  CAS  PubMed  Google Scholar 

  44. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, School of Medicine & Dentistry and North Queensland Centre for Cancer Research, James Cook University, Townsville, QLD, 4814, Australia

    Andrew P. Stillwell & Yik-Hong Ho

  2. Faculty of Health Sciences, Community Based Health Care Research Unit, University of Sydney, Lidcombe, NSW, 1825, Australia

    Craig Veitch

Authors
  1. Andrew P. Stillwell
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  2. Yik-Hong Ho
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  3. Craig Veitch
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Correspondence to Andrew P. Stillwell.

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Stillwell, A.P., Ho, YH. & Veitch, C. Systematic Review of Prognostic Factors Related to Overall Survival in Patients with Stage IV Colorectal Cancer and Unresectable Metastases. World J Surg 35, 684–692 (2011). https://doi.org/10.1007/s00268-010-0891-8

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