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Erschienen in: Annals of Surgical Oncology 9/2014

01.09.2014 | Colorectal Cancer

Prognostic Impact of Primary Tumor Resection and Lymph Node Dissection in Stage IV Colorectal Cancer with Unresectable Metastasis: A Propensity Score Analysis in a Multicenter Retrospective Study

verfasst von: Soichiro Ishihara, MD, PhD, Tamuro Hayama, MD, PhD, Hideki Yamada, MD, PhD, Keijiro Nozawa, MD, PhD, Keiji Matsuda, MD, PhD, Hiroaki Miyata, PhD, Satomi Yoneyama, MD, PhD, Toshiaki Tanaka, MD, PhD, Junichiro Tanaka, MD, PhD, Tomomichi Kiyomatsu, MD, PhD, Kazushige Kawai, MD, PhD, Hioaki Nozawa, MD, PhD, Takamitsu Kanazawa, MD, PhD, Shinsuke Kazama, MD, PhD, Hironori Yamaguchi, MD, PhD, Eiji Sunami, MD, PhD, Joji Kitayama, MD, PhD, Yojiro Hashiguchi, MD, PhD, Kenichi Sugihara, MD, PhD, Toshiaki Watanabe, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2014

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Abstract

Background

Retrospective studies have shown that primary tumor resection improves the prognosis of patients with colorectal cancer with unresectable metastasis (mCRC). Prognostic significance of lymph node dissection (LND) in mCRC has not been examined previously. The aim of this study was to investigate the prognostic impact of primary tumor resection and LND in mCRC.

Methods

A total of 1,982 patients with mCRC from January 1997 to December 2007 were retrospectively studied. The impact of primary tumor resection and LND on overall survival (OS) was analyzed using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Covariates in the models for propensity scores included treatment period, institution, age, sex, carcinoembryonic antigen, tumor location, histology, depth, lymph node metastasis, lymphovascular invasion, and number of metastatic organs.

Results

In a multivariate analysis, primary tumor resection and treatment in the latter period were associated with an improved OS, and age over 70 years, female sex, lymph node metastasis, and multiple organ metastasis were associated with a decreased OS. In the propensity-matched cohort, patients treated with primary tumor resection showed a significantly better OS than those without tumor resection (median OS 13.8 vs. 6.3 months; p = 0.0001). Furthermore, among patients treated with primary tumor resection, patients treated with D3 LND showed a significantly better OS than those with less extensive LND (median OS 17.2 vs. 13.7 months; p < 0.0001).

Conclusions

It was suggested that primary tumor resection with D3 LND improves the survival of patients with mCRC.
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Metadaten
Titel
Prognostic Impact of Primary Tumor Resection and Lymph Node Dissection in Stage IV Colorectal Cancer with Unresectable Metastasis: A Propensity Score Analysis in a Multicenter Retrospective Study
verfasst von
Soichiro Ishihara, MD, PhD
Tamuro Hayama, MD, PhD
Hideki Yamada, MD, PhD
Keijiro Nozawa, MD, PhD
Keiji Matsuda, MD, PhD
Hiroaki Miyata, PhD
Satomi Yoneyama, MD, PhD
Toshiaki Tanaka, MD, PhD
Junichiro Tanaka, MD, PhD
Tomomichi Kiyomatsu, MD, PhD
Kazushige Kawai, MD, PhD
Hioaki Nozawa, MD, PhD
Takamitsu Kanazawa, MD, PhD
Shinsuke Kazama, MD, PhD
Hironori Yamaguchi, MD, PhD
Eiji Sunami, MD, PhD
Joji Kitayama, MD, PhD
Yojiro Hashiguchi, MD, PhD
Kenichi Sugihara, MD, PhD
Toshiaki Watanabe, MD, PhD
Publikationsdatum
01.09.2014
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 9/2014
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3719-1

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