title: Neoadjuvant chemotherapy can improve outcome of colorectal cancer patients with unresectable metastasis.
abstract: BACKGROUND
  The prognosis for colorectal cancer (CRC) patients with unresectable metastases is dismal. This study compared outcomes of different metastatic treatments.
  
  
  METHODS
  We collected 653 CRC cases with unresectable metastases including 490 cases receiving primary tumor resection then chemotherapy (surgery group) and 163 patients receiving neoadjuvant chemotherapy then did or did not receive operations (chemotherapy (C/T) group) from 2004 to 2010. The statistical endpoint was overall survival from the date of diagnosis.
  
  
  RESULTS
  In the C/T group, 124 (76%) patients received an operation after 9.0 ± 6.2 months of chemotherapy, including 57 (34.9%) patients with curative surgery. The C/T group had a higher proportion of T4 lesions (37.4%) than the surgery group (26.9%). Survival of the C/T group was longer than that of the surgery group (28.8 ± 8.8 vs. 24.3 ± 7.5 months; p = 0.043). Survival of 57 patients receiving curative surgery was 36.0 ± 6.3 months, which was significantly better than that of the 67 patients receiving palliative resection (25.2 ± 5.6, p < 0.001). In the surgery group, 42 (8.6%) patients received curative metastasectomy after 8.5 ± 7.1 months of postoperative chemotherapy; survival was 30.8 ± 7.8 months, which was significantly better than that of patients who did not receive metastasectomy (22.4 ± 6.3 months). In multivariate analysis, poor differentiation, lymphovascular invasion, isolated cancer nodules, clinical risk score, and curative surgery were independent prognostic factors of overall patient survival.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy can improve outcome of CRC patients with unresectable metastases.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yen-Chen
authors.initials: YC
authors.lastname: Shao
authors.forename: Yu-Yao
authors.initials: YY
authors.lastname: Chang
authors.forename: Jen-Kou
authors.initials: JK
authors.lastname: Lin
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Lin
authors.forename: Huann-Sheng
authors.initials: HS
authors.lastname: Wang
authors.forename: Shung-Haur
authors.initials: SH
authors.lastname: Yang
authors.forename: Jeng-Kai
authors.initials: JK
authors.lastname: Jiang
authors.forename: Yuan-Tzu
authors.initials: YT
authors.lastname: Lan
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Lin
authors.forename: Anna Fen-Yau
authors.initials: AF
authors.lastname: Li
authors.forename: Wei-Shone
authors.initials: WS
authors.lastname: Chen
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003710:Demography; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents