title: Prognostic Implications of Primary Tumor Resection in Stage IVB Colorectal Cancer in Elderly Patients.
abstract: OBJECTIVE
  The aim of this study was to identify prognostic factors in stage IVB colorectal cancer in elderly patients, focusing on the influence of treatment modalities, including palliative chemotherapy and primary tumor resection.
  
  
  METHODS
  A cohort of 64 patients aged over 65 years who presented with stage IVB colorectal cancer at the Gangneung Asan Hospital between July 1, 2001, and December 31, 2009, was analyzed. Demographics, tumor location, tumor grade, performance status, levels of carcinoembryonic antigen (CEA), level of aspartate aminotransferase (AST), and distant metastatic site at diagnosis were analyzed. Using the treatment histories, we analyzed the prognostic implications of palliative chemotherapy and surgical resection of the primary tumor retrospectively.
  
  
  RESULTS
  The cohort consisted of 30 male (46.9%) and 34 female patients (53.1%); the median age was 76.5 years. Primary tumor resection was done on 28 patients (43.8%); 36 patients (56.2%) were categorized in the nonresection group. The median survival times were 12.43 months in the resection group and 3.58 months in the nonresection group (P < 0.001). Gender, level of CEA, level of AST, Eastern Cooperative Oncology Group performance status, tumor location, and presence of liver metastasis also showed significant differences in overall survival. On multivariate analysis, male gender, higher level of CEA, higher AST level, and no primary tumor resection were independent poor prognostic factors. In particular, nonresection of the primary tumor was the most potent/poor prognostic factor in the elderly-patient study group (P = 0.001; 95% confidence interval, 2.33 to 21.99; hazard ratio, 7.16).
  
  
  CONCLUSIONS
  In stage IVB colorectal cancer in elderly patients, resection of the primary tumor may enhance survival.
authors.affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Heui-June
authors.initials: HJ
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Ho-Suk
authors.initials: HS
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Yongchel
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Hyun Joong
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Moon Ho
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Dae-Woon
authors.initials: DW
authors.lastname: Eom
authors.affiliation: Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Kwak
authors.affiliation: Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Myoung Sik
authors.initials: MS
authors.lastname: Han
authors.affiliation: Department of Preventive Medicine, Kwandong University College of Medicine, Gangneung, Korea.
authors.forename: Jae Seok
authors.initials: JS
authors.lastname: Song
keywords: Colorectal neoplasms; Palliative surgery; Prognosis