title: Identification of patients likely to benefit from metastasectomy in stage IV colorectal cancer.
abstract: OBJECTIVE
  The aim of the present study was to determine selection criteria for patients with stage IV colorectal cancer (CRC) who were likely to show survival benefits of metastasectomy.
  
  
  METHODS
  Clinicopathological data of 119 patients with stage IV CRC who underwent primary CRC resection were retrospectively reviewed. The prognostic factors were analyzed according to the disease resectability status, and patients likely to show survival benefits of metastasectomy were identified.
  
  
  RESULTS
  Metastasectomy was performed in 63 patients. Among these patients, R0 resection was reported in 55 patients, who comprised the curable group. The other 64 patients comprised the noncurable group. For the noncurable group, postoperative chemotherapy was identified as the only significant prognostic factor. In the curable group, T stage, histological type, elevated serum carcinoembryonic antigen (CEA) level and the presence of extra hepatic disease were identified as independent prognostic factors. Patients within the curable group were further classified into a low-risk group (zero to two prognostic factors) and a high-risk group (three or more prognostic factors). The overall survival (OS) of the high risk patients in the curable group was as poor as that of the patients in the noncurable group.
  
  
  CONCLUSIONS
  Stage IV CRC patients consisted of heterogeneous populations who had different prognostic factors, stratified by the disease resectability status. No prognostic benefit of metastasectomy was observed in high-risk patients undergoing curative metastasectomy. These results suggested that patients showing survival benefits of metastasectomy can be identified by considering the prognostic factors in patients undergoing curative metastasectomy.
authors.affiliation: Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Hiroshima University, Hiroshima, Japan. manabus@fuga.ocn.ne.jp
authors.forename: Manabu
authors.initials: M
authors.lastname: Shimomura
authors.forename: Masazumi
authors.initials: M
authors.lastname: Okajima
authors.forename: Takao
authors.initials: T
authors.lastname: Hinoi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Egi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takakura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Adachi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000145:classification / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult