The Survival Benefit of Palliative Resection of Primary Tumor in Colorectal Cancer Patients with Unresectable Metastasis Who Responded to Systematic Therapy
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ABSTRACT:
DISEASE(S): Colorectal Cancer
PROVIDER: 2697075 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:It is still under debate that whether stage IV colorectal cancer patients with unresectable metastasis can benefit from primary tumor resection, especially for asymptomatic colorectal cancer patients. Retrospective studies have shown controversial results concerning the benefit from surgery. This retrospective study aims to evaluate whether the site of primary tumor is a predictor of palliative resection in asymptomatic stage IV colorectal cancer patients.One hundred ninety-four patients with unresectable metastatic colorectal cancer were selected from Sun Yat-sen University Cancer Center Database in the period between January 2007 and December 2013. All information was carefully reviewed and collected, including the treatment, age, sex, carcinoembryonic antigen, site of tumor, histology, cancer antigen 199, number of liver metastases, and largest diameter of liver metastasis. The univariate and multivariate analyses were used to detect the relationship between primary tumor resection and overall survival of unresectable stage IV colorectal cancer patients.One hundred twenty-five received palliative resection, and 69 received only chemotherapy. Multivariate analysis indicated that primary tumor site was one of the independent factors (RR 0.569, P?=?0.007) that influenced overall survival. For left-side colon cancer patients, primary tumor resection prolonged the median overall survival time for 8 months (palliative resection vs. no palliative resection: 22 vs. 14 months, P?=?0.009); however, for right-side colon cancer patients, palliative resection showed no benefit (12 vs. 10 months, P?=?0.910).This study showed that left-side colon cancer patients might benefit from the primary tumor resection in terms of overall survival. This result should be further explored in a prospective study.
| S-EPMC5530936 | biostudies-literature
Project description:Glioblastoma is the most common primary malignant brain tumor in adults and associated with poor survival. Standard-of-care chemotherapy and radiation confer a median overall survival of under two years. The Ivy Foundation Early Phase Clinical Trials Consortium conducted a randomized, multi institution clinical trial to evaluate immune responses and survival following neoadjuvant and/or adjuvant therapy with pembrolizumab, a programmed cell death protein 1 (PD-1) monoclonal antibody, in 35 patients with recurrent, surgically resectable glioblastoma. Patients who were randomized to receive neoadjuvant pembrolizumab, with continued adjuvant therapy following surgery, had significantly extended overall survival compared to patients that were randomized to receive adjuvant, post-surgical PD-1 blockade alone (hazard ratio = 0.39; P = 0.04, log-rank test). Neoadjuvant PD-1 blockade was associated with upregulation of T cell and interferon-γ-related genes, but downregulation of cell cycle related genes within the tumor, which was not seen in patients that received adjuvant therapy alone. Focal induction of programmed death-ligand 1 (PD-L1) in the tumor microenvironment was observed more frequently in the neoadjuvant group than in tumors obtained from patients treated only in the adjuvant setting. Similarly, neoadjuvant pembrolizumab was associated with clonal T cell expansion and the overlap of T cell receptors between tumor and blood, decreased PD-1 expression in T cells and a decreasing peripheral monocytic population. These findings suggest that the neoadjuvant administration of PD-1 blockade enhances the local and systemic anti-tumor immune response and may represent a more efficacious approach to the treatment of this uniformly lethal brain tumor. This trial was registered with ClinicalTrials.gov under the identifier NCT02852655 (https://clinicaltrials.gov/ct2/show/NCT02852655).
2018-12-05 | GSE121810 | GEO
Project description:Interventions: Surgery before chemotherapy group:Resection of primary tumor;Chemotherapy before surgery group:Preoperative chemotherapy;Chemotherapy only group:Chemotherapy only
Primary outcome(s): Overall survival
Study Design: Randomized parallel controlled trial
| 2674496 | ecrin-mdr-crc
Project description:In this study, we evaluated the added value of CMS in predicting both prognosis and benefit of adjuvant chemotherapy in stage III CC patients.
2024-07-10 | GSE250057 | GEO
Project description:Introduction: Palliative surgeries were controversial for asymptomatic metastatic gastric cancer (mGC) patients. This study was aimed to evaluate survival benefit of palliative surgeries to gastric and/or metastatic tumors in mGC patients based on U.S population. Materials and Methods: A total of 8345 gastric cancer patients diagnosed with synchronous distal metastasis between 2004 to 2013 from the Surveillance, Epidemiology, and End Results Program (SEER) database were divided into four groups according to surgery strategies: surgeries to both primary and metastatic tumors (SPM), gastrectomy only (GO), metastasectomy only (MO) and no surgery performed (NS). Their clinicopathological characteristics and overall survival (OS) were analyzed before and after propensity score matching (PSM) and coarsened exact matching (CEM). Results: The median OS of SPM and GO patients was both significantly higher than NS patients (11 months vs. 8 months vs. 5 months; P<0.001, respectively) while that of MO was not (6 months vs. 5 months; P= 0.286). In comparisons between surgery strategies, survival benefit was similar between SPM and GO groups (P=0.389) and both showed significantly better survival than MO patients (P<0.001). All surgery strategies were proved to be favorable prognostic factors over non-surgical treatment (Hazard ratio (HR) for SPM: 0.60, P<0.001; HR for GO: 0.62, P<0.001; HR for MO: 0.91, P=0.046). Similar results were obtained after matching by PSM and CEM except that prognostic impact of MO deteriorated. Conclusions: Gastrectomy plus metastasectomy or gastrectomy alone could be adopted as a choice of improving survival in the U.S population. Metastasectomy alone is not generally recommended.
| S-EPMC6360412 | biostudies-literature
Project description:PurposeWe aimed to explore the value of palliative resection or radiation of primary tumor for metastatic esophageal cancer (EC) patients.MethodsSurveillance, Epidemiology, and End Results database was used for identifying metastatic EC patients. The patients were divided into resection and nonresection groups. And patients without resection were divided into radiation and nonradiation groups. Propensity score matching (PSM) analyses were adopted to reduce the baseline differences between the groups. Cancer specific survivals (CSSs) and overall survivals (OSs) were compared by Kaplan-Meier (K-M) curves. Multivariable analyses by COX proportion hazards model were performed to identify risk factors for CSS and OS. Predictive nomograms were conducted according to both postoperative factors and preoperative factors.ResultsA total of 7982 metastatic EC patients were selected for our analyses. After PSM, 978 patients were included in the survival analyses comparing palliative resection and nonresection. The CSS and OS for patients underwent palliative resection were significantly longer than those without resection (median CSS: 21 months vs 7 months, P < .001; median OS: 20 months vs 7 months, P < .001). In the overall population without resection, 654 patients were matched for radiation and nonradiation groups. And K-M curves showed that patients with radiation had longer CSS and OS than those without radiation (median CSS: 11 months vs 6 months, P < .001; median OS: 10 months vs 6 months, P < .001). Nomograms were generated for prediction of 1-, 2-, and 3-year CSS and OS. All C-indexes implied moderate discrimination and accuracy. And all nomograms had good calibration.ConclusionPalliative resection or radiation of primary tumor could prolong CSS and OS of metastatic EC patients.
| S-EPMC6885868 | biostudies-literature
Project description:We carried out comprehensive analysis for the miRNA profiling of primary tumor and metastatic lesion which seems to be source of circulating miRNA. We picked up two patients who treated with primary tumor resection initially and received chemotherapy followed by surgical resection of liver metastasis. The total miRNA was isolated from frozen tissue specimens. SurePrint G3 Human miRNA microarray kit Rel.21.0 (Agilent Technologies) contains 2549 human microRNA probes. As previously reported, hsa-miR200c revealed specifically high expression in metastatic sites at both two cases. In two colorectal cancer patients, the frozen primary tumor, normal mucosa and liver-metastatic lesion were analyzed by microRNA microarray.
2015-09-19 | E-GEOD-73178 | biostudies-arrayexpress
Project description:Interventions: IOC group:intraoperative chemotherapy (IOC);No-IOC group:without intraoperative chemotherapy (IOC);Stricture:No;No stricture:No;Here 2 positive / RAS mutation / MSI-H / CTC positive:No;Here 2 negative / Ras wild /MSI-L / CTC negative:No
Primary outcome(s): overall survival;Disease free survival
Study Design: Factorial
| 2703941 | ecrin-mdr-crc
Project description:We carried out comprehensive analysis for the miRNA profiling of primary tumor and metastatic lesion which seems to be source of circulating miRNA. We picked up two patients who treated with primary tumor resection initially and received chemotherapy followed by surgical resection of liver metastasis. The total miRNA was isolated from frozen tissue specimens. SurePrint G3 Human miRNA microarray kit Rel.21.0 (Agilent Technologies) contains 2549 human microRNA probes. As previously reported, hsa-miR200c revealed specifically high expression in metastatic sites at both two cases.
2015-09-19 | GSE73178 | GEO
Project description:Background: Current histopathological methods are inadequate for predicting outcome and recurrence in patients with non-small cell lung carcinoma (NSCLC) after surgery. In this study, we investigated the use of gene expression signatures to predict outcome and metastasis in lung cancer patients. Methods: Gene expression was studied by microarray and the real-time reverse transcriptase polymerase chain reaction (RT-PCR) in normal and lung tumor tissue of 188 NSCLC patients who underwent surgical resection. The 5 cancer-related genes and 1 reference gene expression levels measureed by real-time RT-PCR were used in a prospectively defined algorithm to determine the risk for each patient. Finally, we used an independent cohort to verify the 5 gene-based predictive model derived from decision tree analysis. Results: The 5 gene-based decision tree model was able to predict the prognosis. The recurrence rate at 36 months was 53% in the low-risk group versus 83% in the high-risk group (P=0.002). The 5 gene-based model could also predict overall survival (P<0.001). In multivariate analysis, the decision tree model predicted that high-low dichotomy and stage were both significant for recurrence. In addition, it could also predict metastasis and survival of NSCLC patients within the stage I-II subgroups. A similar result was found using an independent cohort of NSCLC patients. The high-risk patients had a significantly poorer overall survival than the low-risk patients (P=0.005). We also found distinct gene signatures which could distinguish between NSCLC, and normal tissue and histology subtypes. Conclusions: A gene expression signature can predict metastasis and survival of NSCLC patients. Keywords: Survival and metastasis analysis
2006-06-07 | GSE4882 | GEO