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原文
The Role of Palliative Resection forAsymptomatic Primary Tumor in Patients With Unresectable Stage IV ColorectalCancer BACKGROUND: The prognostic role of surgical resectionof primary tumors is not well established in patients with asymptomaticunresectable stage IV colorectal cancer. OBJECTIVE: The aims of this study were to reveal theprognostic role of surgical resection of primary tumors and to defineprognostic factors affecting long-term oncological outcomes in patients withasymptomatic unresectable synchronous metastases. DESIGN: This study was a retrospective analysis ofprospectively collected data. PATIENTS: Between 2000 and 2008, a total of 416patients with asymptomatic unresectable stage IV colorectal cancer wereanalyzed with propensity score matching. MAIN OUTCOME MEASURES: Prematching baseline characteristics werecompared by bivariate analysis, and 113 pairs were selected after 1:1 matchingwith propensity scores estimated from logistic regression. The primary endpoint was overall survival. RESULTS: Among 416 patients, 218 (52.4%) underwentpalliative resection of the primary tumor. Before propensity score matching,palliative resection resulted in a better survival rate than nonresection inunivariate analysis (p < 0.001), but not in multivariate analysis (p =0.08). After matching, the 5-year overall survival rate was significantly lowerfor patients with peritoneal metastasis and clinical M1b stage tumors inunivariate analysis (p = 0.004 and p = 0.02). However, neither peritonealmetastasis nor clinical M1b stage showed any prognostic significance inmultivariate analysis. The overall 5-year survival rate of the postmatchinggroup was 4.9% and 3.5% in the palliative resection and nonresection groups.Consequently, palliative resection was not associated with a significantincrease in survival compared with nonresection (p = 0.27). A subgroup analysisperformed according to the site of metastasis also did not show any significantsurvival benefit of palliative resection after matching. LIMITATIONS: Selection bias and potential confounderswere limitations of this study. CONCLUSIONS: Resection of the primary tumor in patientswith asymptomatic unresectable stage IV colorectal cancer was not associatedwith an improvement in overall survival after propensity score matching. |
