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Surgery on primary tumor shows survival benefit in selected stage IV colon cancer patients: A real-world study based on SEER database.

ABSTRACT: Objectives: Most patients with stage IV colon cancer did not have the opportunity for curative surgery, only selected patients could benefit from surgery. This study aimed to determine whether surgery on the primary tumor (SPT) should be performed in patients with stage IV colon cancer and how to select patients for SPT. Methods: This study included 48,933 patients with stage IV colon cancer who were identified in the Surveillance, Epidemiology and End Results (SEER) database between 1998 and 2015. Propensity score matching (PSM) analysis was adopted to balance baseline differences between SPT and non-surgery groups. Kaplan-Meier (K-M) curves were utilized to compare the overall survival (OS). Prognostic nomograms were generated to predict survival based on pre- and post-operative risk factors. Patients were divided into low, middle, and high mortality risk subsets for OS by X-tile analyses based on scores derived from above nomograms. Results: Patients with SPT had a significantly longer OS than those without surgery, regardless of the metastatic sites and diagnostic years. Nomograms, according to the pre- and post-operative risk factors, showed moderate discrimination (all C-indexes above 0.7). Based on X-tile analyses, low mortality risk subset (post-operative score ? 22.3, preoperative score ? 9.7) recommended for SPT, and high mortality risk was not. Conclusions: SPT led to prolonged survival in stage IV colon cancer. Our nomograms would help to select suitable patients for SPT.

SUBMITTER: Xu J

PROVIDER: S-EPMC7150453 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Surgery on primary tumor shows survival benefit in selected stage IV colon cancer patients: A real-world study based on SEER database.

Xu Jing J Ma Tai T Ye Yuanzi Y Pan Zhipeng Z Lu Donghui D Pan Faming F Peng Wanren W Sun Guoping G

Journal of Cancer 20200315 12

<b>Objectives</b>: Most patients with stage IV colon cancer did not have the opportunity for curative surgery, only selected patients could benefit from surgery. This study aimed to determine whether surgery on the primary tumor (SPT) should be performed in patients with stage IV colon cancer and how to select patients for SPT. <b>Methods</b>: This study included 48,933 patients with stage IV colon cancer who were identified in the Surveillance, Epidemiology and End Results (SEER) database betwe ...[more]

PMID: 32284753

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Project description:Background: The role of surgery and surgery type in de novo stage IV breast cancer (BC) is unclear. Methods: We carried out a retrospective cohort study that included the data of 4,108 individuals with de novo stage IV BC abstracted from SEER (Surveillance, Epidemiology, and End Results) data resource from 2010 to 2015. The patients were stratified into the non-surgery group, breast-conserving (BCS) surgery group, and mastectomy group. Inverse probability propensity score weighting (IPTW) was then used to balance clinicopathologic factors. Overall survival (OS), as well as the breast cancer-specific survival (BCSS), was assessed in the three groups using Kaplan-Meier analysis and COX model. Subgroups were stratified by metastatic sites for analysis. Results: Of the 4,108 patients, 48.5% received surgery and were stratified into the BCS group (574 cases) and mastectomy group (1,419 cases). After IPTW balance demographic and clinicopathologic factors, BCS and mastectomy groups had better OS (BCS group: HR, 0.61; 95% CI: 0.49-0.75; mastectomy group: HR, 0.7; 95% CI: 0.63-0.79) and BCSS (BCS group: HR, 0.6; 95% CI, 0.47-0.75; mastectomy group: HR, 0.71; 95% CI, 0.63-0.81) than the non-therapy group. Subgroup analyses revealed that BCS, rather than mastectomy, was linked to better OS (HR, 0.66; 95% CI: 0.48-0.91) and BCSS (HR, 0.63; 95% CI: 0.45-0.89) for patients with bone-only metastasis. For patients with viscera metastasis or bone+viscera metastases, BCS achieved similar OS (viscera metastasis: HR, 1.05; 95% CI: 0.74-1.48; bone+viscera metastases: HR, 1.01; 95% CI: 0.64-1.61) and BCSS (viscera metastasis: HR, 0.94; 95% CI: 0.64-1.38; bone+viscera metastases: HR, 1.06; 95% CI: 0.66-1.73) in contrast with mastectomy. Conclusions: Local surgery for patients with distant metastasis (DS) exhibited a remarkable survival advantage in contrast with non-operative management. BCS may have more survival benefits for patients with de novo stage IV BC with bone-only metastasis than other metastatic sites. Decisions on de novo stage IV BC primary surgery should be tailored to the metastatic pattern.

Dataset Information

Surgery on primary tumor shows survival benefit in selected stage IV colon cancer patients: A real-world study based on SEER database.

Publications

Surgery on primary tumor shows survival benefit in selected stage IV colon cancer patients: A real-world study based on SEER database.

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