title: Concurrent chemoradiotherapy followed by metastasectomy converts to survival benefit in stage IV rectum cancer.
abstract: BACKGROUND
  To investigate the impact of concurrent chemoradiotherapy (CCRT) on stage IV rectum cancer.
  
  
  METHODS
  Between 2000 and 2011, 297 consecutive patients diagnosed with stage IV rectum cancer (synchronous metastasis) were enrolled. Cox proportional hazard analyses were used for prognostic factors determination, and the Kaplan-Meier method was used for survival analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matched patients for validation studies.
  
  
  RESULTS
  In total, 63 patients received CCRT and 234 did not. The patients in the CCRT group were younger, had more low-lying lesions, and had more T4 lesions, lung metastases, metastasectomies, and oxaliplatin-based upfront chemotherapy. Before propensity-score matching, a younger age (HR = 0.662, P = 0.016), lower carcinoembryonic antigen (CEA) level (≤20 ng/ml) (HR = 0.531, P = 0.001), no metastasectomy (HR = 3.214, P < 0.001), and no CCRT (HR = 1.844, P = 0.019) were independent prognostic factors after controlling for other confounding factors. After matching, only CEA and metastasectomy, but not CCRT, were independent prognostic factors. The survival benefit of CCRT was restricted to patients who undergo subsequent metastasectomy.
  
  
  CONCLUSIONS
  Upfront CCRT only provided a survival benefit in patients with stage IV rectum cancer who undergo subsequent metastasectomy.
authors: School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Jen-Kou
authors: JK
authors: Lin
authors: Lin-Kun
authors: LK
authors: Lee
authors: Wei-Shone
authors: WS
authors: Chen
authors: Tzu-Chen
authors: TC
authors: Lin
authors: Jeng-Kai
authors: JK
authors: Jiang
authors: Shung-Haur
authors: SH
authors: Yang
authors: Huann-Sheng
authors: HS
authors: Wang
authors: Shih-Ching
authors: SC
authors: Chang
authors: Yuan-Tzu
authors: YT
authors: Lan
authors: Chun-Chi
authors: CC
authors: Lin
authors: Chueh-Chuan
authors: CC
authors: Yen
authors: Jin-Hwang
authors: JH
authors: Liu
authors: Cheng-Hwai
authors: CH
authors: Tzeng
authors: Hao-Wei
authors: HW
authors: Teng
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000628:therapy*; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin