Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer.
Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer.
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DOI：
10.1002/cncr.30230
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发表时间：
2017-04-01
期刊：
影响因子：
6.2
通讯作者：
Chang GJ
中科院分区：
文献类型：
--
作者：
Alawadi Z;Phatak UR;Hu CY;Bailey CE;You YN;Kao LS;Massarweh NN;Feig BW;Rodriguez-Bigas MA;Skibber JM;Chang GJ
Although safety of combination chemotherapy without primary tumor resection (PTR) in patients with stage 4 colon cancer has been established, questions remain regarding potential survival benefit with PTR. The purpose of this study is to compare mortality rates in colon cancer patients with unresectable metastases who have and have not received PTR. An observational cohort study was conducted of patients with unresectable metastatic colon cancer identified from the National Cancer Data Base(2003-2005). Multivariate Cox regression analysis, with and without Propensity Score Weighting (PSW), was performed to compare survival outcomes. Instrumental Variable (IV) analysis, using the annual hospital-level PTR rate as the instrument, was utilized to account for treatment selection bias. To account for survivor treatment bias, where patients might die soon after diagnosis from different reasons, a landmark method was utilized. PTR was performed in 57% of the total cohort (8641/15154) and 73.8 % of those at landmark (4,972/6,735). PTR was associated with a significant reduction in mortality using Cox regression (HR, 0.45; 95%CI, 0.44-0.47) or PSW (HR, 0.46; 95%CI, 0. 44-0.49). However, IV analysis showed a much smaller effect,(RMR, 0.91; 95%CI, 0.87-0.96). While a smaller benefit was seen on landmark method using Cox regression (HR, 0.6; 95%CI, 0.55-0.64) or PSW (HR, 0.59; 95%CI, 0.54-0.64), IV analysis showed no survival benefit (RMR, 0.97; 95%CI, 0.87-1.06). Among patients with unresectable metastatic colon cancer, following adjustment for confounder effects, PTR was not associated with improved survival when compared to systemic chemotherapy; therefore routine non-curative PTR is not recommended.
