Primary tumor resection in colorectal cancer with unresectable synchronous metastases: A review

Table 2 Prognostic factors associated with overall survival in patients with unresectable metastatic colorectal cancer, according to whether primary tumor resection was performed or not

Ref.	Resection/No resection	No. ofpatients	OS(mo)	P value	PTR on multivariateanalysis [95%CI]	Other independent prognostic factors
Tebbutt et al[34]	Resection	280	14	0.08	No	WHO-PS < 2, no peritoneal dissemination, low phosphatase alkaline and serum albumin levels
	No resection	82	8.2
Law et al[35]	Resection	150	7	< 0.001	OR = 0.42 (0.27–0.66)1P < 0.001	Unilobar LM involvement, no ascites, no chemotherapy
	No resection	30	3
Stelzner et al[45]	Resection	128	11.4	< 0.0001	HR = 0.50 (0.27–0.90) P = 0.0212	No chemotherapy, ASA score < 3, WHO-PS < 2, CEA level, age < 75 yr, extent of metastases, extent of primary tumor
	No resection	58	4.6
Konyalian et al[36]	Resection	62	13	< 0.0001	HR = 0.3 (0.2–0.6) P < 0.00013	Liver involvement < 50%
	No resection	47	5
Yun et al[37]	Resection	283	15.3	< 0.001	HR = 0.53 (0.38–0.73) P < 0.001	Metastatic site ≤ 1, high CEA level, chemotherapy, well-differentiated primary tumor
	No resection	93	5.3
Galizia et al[38]	Resection	42	15.2	0.03	OR = 3.91 (2.83-4.99) 0.26 (0.20-0.35)1P = 0.001	WHO-PS < 2, liver involvement < 50%
	No resection	23	12.3
Bajwa et al[39]	Resection	32	14	0.005	OR = 0.26 (0.13-0.52) P = 0.0001	Left sided primary tumor, unique primary tumor
	No resection	35	6
Mik et al[40]	Resection	52	21	NS	HR = 0.58 (0.36–0.82)1P = 0.004	Unilobar LM involvement
	No resection	82	14
Aslam et al[41]	Resection	366	14.5	< 0.005	P < 0.001	Age < 80 yr, non-locally advanced primary tumor, N + stage
	No resection	281	5.83
Karoui et al[33]	Resection	128	30.7	0.031 -	HR = 0.56 (0.38–0.83)1P = 0.004	Secondary curative resection, well-differentiated primary tumor, anti-VEGF treatment, no extra-hepatic metastases
	No resection	85	21.9
Platell et al[83]	Resection	243	-		HR = 0.51 (0.37–0.69) P = 0.0001	Chemotherapy, radiotherapy, ASA score < 3
	No resection	70	-
Venderbosch et al[12]	Resection	286	14	< 0.001	HR = 0.73 (0.58-0.93) P = 0.01	-
	No resection	125	6
Ferrand et al[22]	Resection	156	16.3	< 0.0001	HR = 0.42 (0.30-0.60) P < 0.0001	WHO-PS < 2, distal colon or rectal primary tumor, one metastatic site and alkaline phosphatase ≤ 300 UI/L
	No resection	60	9.5

¹For readability of the Table, some ORs and HRs have been recalculated with “ No resection” as reference for the multivariate analysis of survival;

²excluding postoperative mortality and complicated primary tumor;

³PTR was independently associated with increased survival probability, while adjusting on patient’s age, sex and degree of hepatic tumor involvement. OS: Overall survival; PTR: Primary tumor resection; OR: Odds ratio; HR: Hazard ratio; LM: Liver metastases; ASA: American society of anesthesiology; CEA: Carcinoembryonic antigen; VEGF: Vascular-endothelial growth factor; WHO-PS: World health organization performance status; NS: Not significant.