Prognostic Value of Resection of Primary Tumor in Patients with Stage IV Colorectal Cancer: Retrospective Analysis of Two Randomized Studies and a Review of the Literature

• Published in: Annals of surgical oncology Vol. 18; no. 12; pp. 3252 - 3260
• Main Authors: Venderbosch, Sabine, de Wilt, Johannes H., Teerenstra, Steven, Loosveld, Olaf J., van Bochove, Aart, Sinnige, Harm A., Creemers, Geert-Jan M., Tesselaar, Margot E., Mol, Linda, Punt, Cornelis J. A., Koopman, Miriam
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.11.2011; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Clinical Trials, Phase III as Topic; Colorectal Cancer; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Prognosis; Randomized Controlled Trials as Topic; Retrospective Studies; Review Literature as Topic; Surgery; Surgical Oncology; Survival Rate; Cetuximab; Resection Group; Overall Survival; Primary Tumor; Median Overall Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-011-1951-5

Background In patients with metastatic colorectal cancer (mCRC) with an asymptomatic primary tumor, there is no consensus on the indication for resection of the primary tumor. Methods A retrospective analysis was performed on the outcome of stage IV colorectal cancer (CRC) patients with or without resection of the primary tumor treated in the phase III CAIRO and CAIRO2 studies. A review of the literature was performed. Results In the CAIRO and CAIRO2 studies, 258 and 289 patients had undergone a primary tumor resection and 141 and 159 patients had not, respectively. In the CAIRO study, a significantly better median overall survival and progression-free survival was observed for the resection compared to the nonresection group, with 16.7 vs. 11.4 months [ P  < 0.0001, hazard ratio (HR) 0.61], and 6.7 vs. 5.9 months ( P  = 0.004; HR 0.74), respectively. In the CAIRO2 study, median overall survival and progression-free survival were also significantly better for the resection compared to the nonresection group, with 20.7 vs. 13.4 months ( P  < 0.0001; HR 0.65) and 10.5 vs. 7.8 months ( P  = 0.014; HR 0.78), respectively. These differences remained significant in multivariate analyses. Our review identified 22 nonrandomized studies, most of which showed improved survival for mCRC patients who underwent resection of the primary tumor. Conclusions Our results as well as data from literature indicate that resection of the primary tumor is a prognostic factor for survival in stage IV CRC patients. The potential bias of these results warrants prospective studies on the value of resection of primary tumor in this setting; such studies are currently being planned.