Influence of primary tumor location and resection on survival in metastatic colorectal cancer

doi:10.4251/wjgo.v12.i11.1296

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World Journal of Gastrointestinal Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

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.

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

ARTICLE HIGHLIGHTS

Research background

Patients with right sided colorectal cancer (CRC) are known to have a poorer prognosis than patients with left sided tumors and primary tumor resection (PTR) is controversial whatever the primary tumor location (PTL).

Research motivation

Results concerning PTR in unresectable metastatic colorectal cancer (mCRC) are non-consensual and PTR is not a standard practice. To our knowledge, the outcome of PTR in terms of overall survival (OS) depending on tumor sidedness has never been evaluated.

Research objectives

This study aimed to explore the survival impact of PTR in patients with mCRC depending on PTL.

Research 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 associations between PTL and OS among patients who previously underwent or did not undergo PTR. A propensity score was performed to match cohorts.

Research 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 OS rates. Survival evaluation depending on PTR and PTL found that PTR improved the prognosis of both left and right sided unresectable mCRC. Results were confirmed by using a weighted propensity score.

Research conclusions

In mCRC, PTR seems to confer higher survival rates whatever the PTL.

Research perspectives

These results are in favor of PTR for patients treated for a mCRC but would need to be supported by a large scale, prospective trial.