Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2020; 12(11): 1296-1310
Published online Nov 15, 2020. doi: 10.4251/wjgo.v12.i11.1296
Influence of primary tumor location and resection on survival in metastatic colorectal cancer
Zoé Tharin, Julie Blanc, Ikram Charifi Alaoui, Aurélie Bertaut, François Ghiringhelli
Zoé Tharin, François Ghiringhelli, Department of Medical Oncology, Centre Georges-François Leclerc, Dijon 21000, France
Julie Blanc, Ikram Charifi Alaoui, Aurélie Bertaut, Department of Bioastatistics, Centre Georges-François Leclerc, Dijon 21000, France
Author contributions: All authors have contributed to the paper concept and design and agreed on the final content of the manuscript; Tharin Z and Charifi Alaoui I acquired the data; Blanc J and Bertaut A performed the statistical analysis; Tharin Z drafted the manuscript under the supervision of senior author Ghiringhelli F; all authors critically revised the manuscript and approved the final version of the manuscript.
Institutional review board statement: I declare that, the database was registered and declared to the Clinical Trial database (NCT04031625). The study was conducted in accordance with standard procedures in France with approval from relevant institutional review boards called (CNIL).
Informed consent statement: I declare that all patients gave their informed consent before participating to this retrospective study.
Conflict-of-interest statement: All authors declare no conflict-of-interest related to this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zoé Tharin, MD, Doctor, Department of Medical Oncology, Centre Georges-François Leclerc, 1 rue du Professeur Marion, Dijon 21000, France. ztharin@cgfl.fr
Received: June 8, 2020
Peer-review started: June 8, 2020
First decision: September 11, 2020
Revised: September 25, 2020
Accepted: October 28, 2020
Article in press: October 28, 2020
Published online: November 15, 2020
Processing time: 156 Days and 20 Hours
Abstract
BACKGROUND

Patients with right sided colorectal cancer are known to have a poorer prognosis than patients with left sided colorectal cancer, whatever the cancer stage. To this day, primary tumor resection (PTR) is still controversial in a metastatic, non resectable setting.

AIM

To explore the survival impact of PTR in patients with metastatic colorectal cancer (mCRC) depending on PTL.

METHODS

We retrospectively collected data from all consecutive patients treated for mCRC at the Centre Georges Francois Leclerc Hospital. Univariate and multivariate Cox proportional hazard regression models were used to assess the influence of PTR on survival. We then evaluated the association between PTL and overall survival among patients who previously underwent or did not undergo PTR. A propensity score was performed to match cohorts.

RESULTS

Four hundred and sixty-six patients were included. A total of 153 (32.8%) patients had unresected synchronous mCRC and 313 (67.2%) patients had resected synchronous mCRC. The number of patients with right colic cancer, left colic cancer and rectal cancer was respectively 174 (37.3%), 203 (43.6%) and 89 (19.1%). In the multivariate analysis only PTL, PTR, resection of hepatic and or pulmonary metastases and the use of oxaliplatin, EGFR inhibitors or bevacizumab throughout treatment were associated to higher overall survival rates. Survival evaluation depending on PTR and PTL found that PTR improved the prognosis of both left and right sided mCRC. Results were confirmed by using a weighted propensity score.

CONCLUSION

In mCRC, PTR seems to confer a higher survival rate to patients whatever the PTL.

Keywords: Colorectal cancer; Metastatic; Primary tumor resection; Chemotherapy; Primary tumor location; Synchronous

Core Tip: This article presents a large, real life, cohort of patients treated for a metastatic colorectal cancer. Primary tumor resection in this setting is not a validated systematic treatment. However, in our hospital, primary tumor resection is performed widely. In our study, primary tumor resection was associated to higher overall survival rates even in patients with a poor prognosis. We also looked at the impact of primary tumor resection depending on primary tumor location. Primary tumor location had no impact on the benefit provided by primary tumor resection.