TY - JOUR
T1 - Primary Tumor Resection for Rectal Cancer With Unresectable Liver Metastases
T2 - A Chance to Cut Is a Chance for Improved Survival
AU - Chen, Jia Nan
AU - Shoucair, Sami
AU - Wang, Zheng
AU - Habib, Joseph R.
AU - Zhao, Fu Qiang
AU - Yu, Jun
AU - Liu, Zheng
AU - Liu, Qian
N1 - Funding Information:
This work was supported by the National Key Research and Development Program of China Major Chronic
Funding Information:
The authors acknowledge the great efforts of the Surveillance, Epidemiology, and End Results (SEER) Program in the creation of the SEER database. Funding. This work was supported by the National Key Research and Development Program of China Major Chronic Non-communicable Disease Prevention and Control Research (No. 2019YFC1315705); the Beijing Marathon of Hope, Cancer Foundation of China (No. LC2017L07); the Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences (No. 2017-12M-1-006).
Publisher Copyright:
© Copyright © 2021 Chen, Shoucair, Wang, Habib, Zhao, Yu, Liu and Liu.
PY - 2021/3/15
Y1 - 2021/3/15
N2 - Background: About half of the patients with rectal cancer will develop liver metastasis during the course of their illness. Unfortunately, a large proportion of these metastases are unresectable. Surgical resection of the primary tumor vs. palliative treatment in patients with unresectable synchronous liver metastases remains controversial. Methods: Patients with rectal cancer with surgically unresectable liver metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010, to December 31, 2015. According to different treatment modalities, patients were divided into a primary tumor resection group and a non-resection group. Rates of primary tumor resection and survival were calculated for each year. Kaplan–Meier methods and Cox regression models were used to assess long-term survival. Multivariable logistic regression models were used to evaluate factors potentially associated with primary tumor resection. Results: Among 1,957 patients, 494 (25.2%) had undergone primary tumor resection. Patients with primary tumor resection had significantly better 5-year survival rate (27.2 vs. 5.6%, P < 0.001) compared to the non-resection group. Chemoradiotherapy with primary site resection was associated with the longest mean and 5-year OS (44.7 months, 32.4%). The Cox regression analyses of the subgroup indicated that patients who underwent primary tumor resection had improved survival compared with those who did not undergo resection in all 25 subgroups. Factors associated with primary tumor resection were well or moderately differentiated tumor grade, undergoing radiation, and primary tumor size <5 cm. Conclusions: The majority of patients with rectal cancer with unresectable liver metastases did not undergo primary tumor resection. Our results indicate that resection of the primary tumor appears to offer the greatest chance of survival. Prospective studies are needed to confirm these results.
AB - Background: About half of the patients with rectal cancer will develop liver metastasis during the course of their illness. Unfortunately, a large proportion of these metastases are unresectable. Surgical resection of the primary tumor vs. palliative treatment in patients with unresectable synchronous liver metastases remains controversial. Methods: Patients with rectal cancer with surgically unresectable liver metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010, to December 31, 2015. According to different treatment modalities, patients were divided into a primary tumor resection group and a non-resection group. Rates of primary tumor resection and survival were calculated for each year. Kaplan–Meier methods and Cox regression models were used to assess long-term survival. Multivariable logistic regression models were used to evaluate factors potentially associated with primary tumor resection. Results: Among 1,957 patients, 494 (25.2%) had undergone primary tumor resection. Patients with primary tumor resection had significantly better 5-year survival rate (27.2 vs. 5.6%, P < 0.001) compared to the non-resection group. Chemoradiotherapy with primary site resection was associated with the longest mean and 5-year OS (44.7 months, 32.4%). The Cox regression analyses of the subgroup indicated that patients who underwent primary tumor resection had improved survival compared with those who did not undergo resection in all 25 subgroups. Factors associated with primary tumor resection were well or moderately differentiated tumor grade, undergoing radiation, and primary tumor size <5 cm. Conclusions: The majority of patients with rectal cancer with unresectable liver metastases did not undergo primary tumor resection. Our results indicate that resection of the primary tumor appears to offer the greatest chance of survival. Prospective studies are needed to confirm these results.
KW - liver
KW - metastasis
KW - rectal cancer
KW - resection
KW - SEER (Surveillance Epidemiology and End Results) database
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U2 - 10.3389/fonc.2021.628715
DO - 10.3389/fonc.2021.628715
M3 - Article
C2 - 33791215
AN - SCOPUS:85103504298
VL - 11
JO - Frontiers in Oncology
JF - Frontiers in Oncology
SN - 2234-943X
M1 - 628715
ER -