Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: Individual patient data analysis of first-line randomised trials from the ARCAD database

K. L. van Rooijen, Qian D Shi, K. K.H. Goey, J. Meyers, V. Heinemann, E. Diaz-Rubio, E. Aranda, A. Falcone, E. Green, A. de Gramont, D. J. Sargent, C. J.A. Punt, M. Koopman

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Indication for primary tumour resection (PTR) in asymptomatic metastatic colorectal cancer (mCRC) patients is unclear. Previous retrospective analyses suggest a survival benefit for patients who underwent PTR. The aim was to evaluate the prognostic value of PTR in patients with synchronous mCRC by analysis of recent large RCTs including systemic therapy with modern targeted agents. Individual patient data (IPD) of 3423 patients enrolled into 8 randomised controlled trials (RCTs) with first-line systemic therapy in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were analysed. The number of patients with unresected synchronous mCRC, resected synchronous mCRC and metachronous mCRC was 710 (21%), 1705 (50%) and 1008 (29%), respectively. Adjusting for age, gender, performance status (PS) and prior chemotherapy, the unresected group had a significantly worse median overall survival (16.4 m) compared with the synchronous resected (22.2 m; hazard ratio [HR] 1.60, 95% CI 1.43–1.78) and metachronous (22.4 m; HR 1.81, 95% CI 1.58–2.07) groups. Similarly, median progression-free survival was significantly worse for the unresected group compared with the synchronous resected (HR 1.31, 95% CI 1.19–1.44) and metachronous (HR 1.47, 95% CI 1.30–1.66) groups. In a multivariate analysis, the observed associations remained significant. This largest IPD analysis of mCRC trials to date demonstrates an improved survival in synchronous mCRC patients after PTR. These results may be subject to bias since reasons for (non)resection were not available. Until results of ongoing RCTs are available, both upfront PTR followed by systemic treatment and upfront systemic treatment are considered appropriate treatment strategies.

Original languageEnglish (US)
Pages (from-to)99-106
Number of pages8
JournalEuropean Journal of Cancer
Volume91
DOIs
StatePublished - Mar 1 2018

Fingerprint

Colorectal Neoplasms
Databases
Neoplasms
Randomized Controlled Trials
Survival
Therapeutics
Disease-Free Survival
Multivariate Analysis
Drug Therapy

Keywords

  • Palliative treatment
  • Resection primary tumour
  • Synchronous metastatic colorectal cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer : Individual patient data analysis of first-line randomised trials from the ARCAD database. / van Rooijen, K. L.; Shi, Qian D; Goey, K. K.H.; Meyers, J.; Heinemann, V.; Diaz-Rubio, E.; Aranda, E.; Falcone, A.; Green, E.; de Gramont, A.; Sargent, D. J.; Punt, C. J.A.; Koopman, M.

In: European Journal of Cancer, Vol. 91, 01.03.2018, p. 99-106.

Research output: Contribution to journalArticle

van Rooijen, KL, Shi, QD, Goey, KKH, Meyers, J, Heinemann, V, Diaz-Rubio, E, Aranda, E, Falcone, A, Green, E, de Gramont, A, Sargent, DJ, Punt, CJA & Koopman, M 2018, 'Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: Individual patient data analysis of first-line randomised trials from the ARCAD database', European Journal of Cancer, vol. 91, pp. 99-106. https://doi.org/10.1016/j.ejca.2017.12.014
van Rooijen, K. L. ; Shi, Qian D ; Goey, K. K.H. ; Meyers, J. ; Heinemann, V. ; Diaz-Rubio, E. ; Aranda, E. ; Falcone, A. ; Green, E. ; de Gramont, A. ; Sargent, D. J. ; Punt, C. J.A. ; Koopman, M. / Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer : Individual patient data analysis of first-line randomised trials from the ARCAD database. In: European Journal of Cancer. 2018 ; Vol. 91. pp. 99-106.
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abstract = "Indication for primary tumour resection (PTR) in asymptomatic metastatic colorectal cancer (mCRC) patients is unclear. Previous retrospective analyses suggest a survival benefit for patients who underwent PTR. The aim was to evaluate the prognostic value of PTR in patients with synchronous mCRC by analysis of recent large RCTs including systemic therapy with modern targeted agents. Individual patient data (IPD) of 3423 patients enrolled into 8 randomised controlled trials (RCTs) with first-line systemic therapy in the ARCAD (Aide et Recherche en Canc{\'e}rologie Digestive) database were analysed. The number of patients with unresected synchronous mCRC, resected synchronous mCRC and metachronous mCRC was 710 (21{\%}), 1705 (50{\%}) and 1008 (29{\%}), respectively. Adjusting for age, gender, performance status (PS) and prior chemotherapy, the unresected group had a significantly worse median overall survival (16.4 m) compared with the synchronous resected (22.2 m; hazard ratio [HR] 1.60, 95{\%} CI 1.43–1.78) and metachronous (22.4 m; HR 1.81, 95{\%} CI 1.58–2.07) groups. Similarly, median progression-free survival was significantly worse for the unresected group compared with the synchronous resected (HR 1.31, 95{\%} CI 1.19–1.44) and metachronous (HR 1.47, 95{\%} CI 1.30–1.66) groups. In a multivariate analysis, the observed associations remained significant. This largest IPD analysis of mCRC trials to date demonstrates an improved survival in synchronous mCRC patients after PTR. These results may be subject to bias since reasons for (non)resection were not available. Until results of ongoing RCTs are available, both upfront PTR followed by systemic treatment and upfront systemic treatment are considered appropriate treatment strategies.",
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AU - Goey, K. K.H.

AU - Meyers, J.

AU - Heinemann, V.

AU - Diaz-Rubio, E.

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AU - Falcone, A.

AU - Green, E.

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