Purpose: With the improvements in newer chemotherapeutic agents, there is currently no consensus regarding the validity of palliative resection of the primary tumor for colorectal cancer with incurable distant metasta...Purpose: With the improvements in newer chemotherapeutic agents, there is currently no consensus regarding the validity of palliative resection of the primary tumor for colorectal cancer with incurable distant metastasis. We retrospectively analyzed prognostic factor in patients with colorectal cancer accompanied by incurable synchronous liver metastasis. Methods: 82 patients with incurable synchronous liver metastases, who underwent primary tumor resection alone, were enrolled. Results: The multivariate analysis revealed that the presence of ascites (P = 0.001, Hazard ratio = 2.96) and differentiation (P = 0.003, Hazard ratio = 3.68) were found to be significant independent prognostic factors. The median survival time among the patients with ascites was 4.8 months and that among the patients with poorly-differentiated or mucinous adenocarcinoma, or signet ring cell carcinoma (high grade differentiation) was 1.4 months, respectively. Conclusion: The presence of ascites and differentiation were prognostic factors in the patients with incurable liver metastases. Therefore, because prognosis is generally poor after primary tumor resection in the patients with ascites or high grade differentiation, the introduction of systemic chemotherapy with alleviation of symptoms related to the primary tumor should be taken into account as one of the therapeutic strategies.展开更多
Background: It remains controversial whether palliative primary tumor resection(PPTR) can provide survival benefits to the patients with metastatic colorectal cancer(m CRC) who have unresectable metastases. The aim of...Background: It remains controversial whether palliative primary tumor resection(PPTR) can provide survival benefits to the patients with metastatic colorectal cancer(m CRC) who have unresectable metastases. The aim of this study was to evaluate whether PPTR could improve the survival of patients with m CRC.Methods: We conducted a retrospective study on consecutive m CRC patients with unresectable metastases who were diagnosed at Sun Yat?sen University Cancer Center in Guangzhou, Guangdong, China, between January 2005 and December 2012. Overall survival(OS) and progression?free survival(PFS) after first?line chemotherapy failure were compared between the PPTR and non?PPTR patient groups.Results: A total of 387 patients were identified, including 254 who underwent PPTR and 133 who did not. The median OS of the PPTR and non?PPTR groups was 20.8 and 14.8 months(P < 0.001), respectively. The median PFS after first?line chemotherapy was 7.3 and 4.8 months(P < 0.001) in the PPTR and non?PPTR groups, respectively. A larger proportion of patients in the PPTR group(219 of 254, 86.2%) showed local progression compared with that of patients in the non?PPTR group(95 of 133, 71.4%; P < 0.001). Only patients with normal lactate dehydrogenase(LDH) levels and with carcinoembryonic antigen(CEA) levels <70 ng/m L benefited from PPTR(median OS, 22.2 months for the PPTR group and 16.2 months for the non?PPTR group; P < 0.001).Conclusions: For m CRC patients with unresectable metastases, PPTR can improve OS and PFS after first?line chemo?therapy and decrease the incidence of new organ involvement. However, PPTR should be recommended only for patients with normal LDH levels and with CEA levels <70 ng/m L.展开更多
文摘Purpose: With the improvements in newer chemotherapeutic agents, there is currently no consensus regarding the validity of palliative resection of the primary tumor for colorectal cancer with incurable distant metastasis. We retrospectively analyzed prognostic factor in patients with colorectal cancer accompanied by incurable synchronous liver metastasis. Methods: 82 patients with incurable synchronous liver metastases, who underwent primary tumor resection alone, were enrolled. Results: The multivariate analysis revealed that the presence of ascites (P = 0.001, Hazard ratio = 2.96) and differentiation (P = 0.003, Hazard ratio = 3.68) were found to be significant independent prognostic factors. The median survival time among the patients with ascites was 4.8 months and that among the patients with poorly-differentiated or mucinous adenocarcinoma, or signet ring cell carcinoma (high grade differentiation) was 1.4 months, respectively. Conclusion: The presence of ascites and differentiation were prognostic factors in the patients with incurable liver metastases. Therefore, because prognosis is generally poor after primary tumor resection in the patients with ascites or high grade differentiation, the introduction of systemic chemotherapy with alleviation of symptoms related to the primary tumor should be taken into account as one of the therapeutic strategies.
基金supported by grants from the Natural Science Foundation of Guangdong, China (2015A030313010)Science and Technology Program of Guangzhou, China (1563000305)National Natural Science Foundation of China (81272641 and 81572409)
文摘Background: It remains controversial whether palliative primary tumor resection(PPTR) can provide survival benefits to the patients with metastatic colorectal cancer(m CRC) who have unresectable metastases. The aim of this study was to evaluate whether PPTR could improve the survival of patients with m CRC.Methods: We conducted a retrospective study on consecutive m CRC patients with unresectable metastases who were diagnosed at Sun Yat?sen University Cancer Center in Guangzhou, Guangdong, China, between January 2005 and December 2012. Overall survival(OS) and progression?free survival(PFS) after first?line chemotherapy failure were compared between the PPTR and non?PPTR patient groups.Results: A total of 387 patients were identified, including 254 who underwent PPTR and 133 who did not. The median OS of the PPTR and non?PPTR groups was 20.8 and 14.8 months(P < 0.001), respectively. The median PFS after first?line chemotherapy was 7.3 and 4.8 months(P < 0.001) in the PPTR and non?PPTR groups, respectively. A larger proportion of patients in the PPTR group(219 of 254, 86.2%) showed local progression compared with that of patients in the non?PPTR group(95 of 133, 71.4%; P < 0.001). Only patients with normal lactate dehydrogenase(LDH) levels and with carcinoembryonic antigen(CEA) levels <70 ng/m L benefited from PPTR(median OS, 22.2 months for the PPTR group and 16.2 months for the non?PPTR group; P < 0.001).Conclusions: For m CRC patients with unresectable metastases, PPTR can improve OS and PFS after first?line chemo?therapy and decrease the incidence of new organ involvement. However, PPTR should be recommended only for patients with normal LDH levels and with CEA levels <70 ng/m L.
