Li CL, Tang DR, Ji J, Zang B, Chen C, Zhao JQ. Colorectal adenocarcinoma patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases: A propensity score matching analysis. World J Clin Cases 2020; 8(15): 3230-3239 [PMID: 32874977 DOI: 10.12998/wjcc.v8.i15.3230]
Corresponding Author of This Article
Jian-Qiang Zhao, MD, Doctor, Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, No. 1 West Huanghe Road, Huaian 223300, Jiangsu Province, China. shenglee6871@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Clin Cases. Aug 6, 2020; 8(15): 3230-3239 Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3230
Colorectal adenocarcinoma patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases: A propensity score matching analysis
Cheng-Lin Li, De-Rong Tang, Jian Ji, Bao Zang, Chen Chen, Jian-Qiang Zhao
Cheng-Lin Li, De-Rong Tang, Jian Ji, Bao Zang, Chen Chen, Jian-Qiang Zhao, Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Author contributions: Li CL and Zhao JQ designed the research and critically revised the manuscript for important intellectual content; all authors performed the research, analyzed the data, and wrote the paper.
Institutional review board statement: The study was approved by the Bioethics Committee of the Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, China.
Informed consent statement: All patients from the SEER database have agreed to participate in scientific research.
Conflict-of-interest statement: All authors declare no competing financial interests.
Data sharing statement: No additional data are available.
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: Jian-Qiang Zhao, MD, Doctor, Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, No. 1 West Huanghe Road, Huaian 223300, Jiangsu Province, China. shenglee6871@sina.com
Received: January 14, 2020 Peer-review started: January 14, 2020 First decision: April 12, 2020 Revised: April 25, 2020 Accepted: June 29, 2020 Article in press: June 29, 2020 Published online: August 6, 2020
ARTICLE HIGHLIGHTS
Research background
The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery for metastatic colorectal adenocarcinoma (CRA) unless there is a risk of significant acute bleeding, obstruction, perforation, or another severe symptom.
Research motivation
Accumulating evidence has demonstrated that palliative surgery for metastatic CRA patients was associated with more favorable outcomes. However, no studies further classified CRA patients with stage IV into subsets to assess the role of palliative surgery.
Research objectives
The purpose of this study was to investigate the separate role of palliative primary tumor resection for CRA patients with stage IVA (M1a diseases) and stage IVB (M1b diseases).
Research methods
CRA patient records with definite M1a and M1b categories were analyzed by adjusted propensity score matching. Patient prognosis was assessed by univariate and multivariate Cox regression analyses with hazard ratios and 95% confidence intervals.
Research results
Patients with metastatic CRA receiving palliative primary tumor resection had a longer survival time than those who did not (P < 0.001). Palliative resection increased the median survival time by 9 mo and by 7 mo for patients with M1a and M1b diseases, respectively. For M1a diseases, patients with lung metastasis had more survival benefit from palliative resection than those with liver metastasis (15 mo for lung metastasis vs 8 mo for liver metastasis, P < 0.001).
Research conclusions
Palliative primary tumor resection improves survival for all CRA patients but more beneficial for those with M1a diseases than those with M1b diseases. Specifically, patients with M1a (lung metastasis) had the best long-term outcomes after palliative primary tumor resection.
Research perspectives
These findings provided further evidence to support the use of palliative surgical procedures to treat metastatic CRA and develop effective individualized treatment strategies.
