title: Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy: results from the multicenter, randomised trial Fédération Francophone de Cancérologie Digestive 9601.
abstract: OBJECTIVE
  To assess the impact of primary tumour resection on overall survival (OS) of patients diagnosed with stage IV colorectal cancer (CRC).
  
  
  METHODS
  Among the 294 patients with non-resectable colorectal metastases enrolled in the Fédération Francophone de Cancérologie Digestive (FFCD) 9601 phase III trial, which compared different first-line single-agent chemotherapy regimens, 216 patients (73%) presented with synchronous metastases at study entry and constituted the present study population. Potential baseline prognostic variables including prior primary tumour resection were assessed by univariate and multivariate Cox analyses. Progression-free survival (PFS) and OS curves were compared with the logrank test.
  
  
  RESULTS
  Among the 216 patients with stage IV CRC (median follow-up, 33 months), 156 patients (72%) had undergone resection of their primary tumour prior to study entry. The resection and non-resection groups did not differ for baseline characteristics except for primary tumour location (rectum, 14% versus 35%; p=0.0006). In multivariate analysis, resection of the primary was the strongest independent prognostic factor for PFS (hazard ratio (HR), 0.5; 95% confidence interval [CI], 0.4-0.8; p=0.0002) and OS (HR, 0.4; CI, 0.3-0.6; p<0.0001). Both median PFS (5.1 [4.6-5.6] versus 2.9 [2.2-4.1] months; p=0.001) and OS (16.3 [13.7-19.2] versus 9.6 [7.4-12.5]; p<0.0001) were significantly higher in the resection group. These differences in patient survival were maintained after exclusion of patients with rectal primary (n=43).
  
  
  CONCLUSIONS
  Resection of the primary tumour may be associated with longer PFS and OS in patients with stage IV CRC starting first-line, single-agent chemotherapy.
authors.affiliation: Institut Gustave Roussy, Gastro-intestinal Unit, Department of Oncologic Medicine, Université Paris Sud, Villejuif, France.
authors.forename: F
authors.initials: F
authors.lastname: Ferrand
authors.forename: D
authors.initials: D
authors.lastname: Malka
authors.forename: A
authors.initials: A
authors.lastname: Bourredjem
authors.forename: C
authors.initials: C
authors.lastname: Allonier
authors.forename: O
authors.initials: O
authors.lastname: Bouché
authors.forename: S
authors.initials: S
authors.lastname: Louafi
authors.forename: V
authors.initials: V
authors.lastname: Boige
authors.forename: M
authors.initials: M
authors.lastname: Mousseau
authors.forename: J L
authors.initials: JL
authors.lastname: Raoul
authors.forename: L
authors.initials: L
authors.lastname: Bedenne
authors.forename: B
authors.initials: B
authors.lastname: Leduc
authors.forename: P
authors.initials: P
authors.lastname: Deguiral
authors.forename: M
authors.initials: M
authors.lastname: Faron
authors.forename: J P
authors.initials: JP
authors.lastname: Pignon
authors.forename: M
authors.initials: M
authors.lastname: Ducreux
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents