Identification of patients likely to benefit from metastasectomy in stage IV colorectal cancer

• Published in: International journal of colorectal disease Vol. 27; no. 10; pp. 1339 - 1346
• Main Authors: Shimomura, Manabu, Okajima, Masazumi, Hinoi, Takao, Egi, Hiroyuki, Takakura, Yuji, Kawaguchi, Yasuo, Tokunaga, Masakazu, Adachi, Tomohiro, Tashiro, Hirotaka, Ohdan, Hideki
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.10.2012; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Cancer; Cancer patients; CEA (Oncology); Chemotherapy; Colorectal cancer; Colorectal Neoplasms - classification; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Gastroenterology; Hepatology; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Metastasectomy; Middle Aged; Multivariate Analysis; Neoplasm Staging; Oncology, Experimental; Original Article; Proctology; Prognosis; Risk Factors; Surgery; Survival Analysis; Young Adult; Metastasectomy; Stage IV; Resectability status; Colorectal cancer; Selection criteria
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-012-1454-2

Purpose The aim of the present study was to determine selection criteria for patients with stage IV colorectal cancer (CRC) who were likely to show survival benefits of metastasectomy. Methods Clinicopathological data of 119 patients with stage IV CRC who underwent primary CRC resection were retrospectively reviewed. The prognostic factors were analyzed according to the disease resectability status, and patients likely to show survival benefits of metastasectomy were identified. Results Metastasectomy was performed in 63 patients. Among these patients, R0 resection was reported in 55 patients, who comprised the curable group. The other 64 patients comprised the noncurable group. For the noncurable group, postoperative chemotherapy was identified as the only significant prognostic factor. In the curable group, T stage, histological type, elevated serum carcinoembryonic antigen (CEA) level and the presence of extra hepatic disease were identified as independent prognostic factors. Patients within the curable group were further classified into a low-risk group (zero to two prognostic factors) and a high-risk group (three or more prognostic factors). The overall survival (OS) of the high risk patients in the curable group was as poor as that of the patients in the noncurable group. Conclusions Stage IV CRC patients consisted of heterogeneous populations who had different prognostic factors, stratified by the disease resectability status. No prognostic benefit of metastasectomy was observed in high-risk patients undergoing curative metastasectomy. These results suggested that patients showing survival benefits of metastasectomy can be identified by considering the prognostic factors in patients undergoing curative metastasectomy.