title: Primary Tumor Resection Is Associated with Improved Survival in Stage IV Colorectal Cancer: An Instrumental Variable Analysis.
abstract: Primary tumor resection (PTR) is recommended for patients with unresectable stage IV colorectal cancer (CRC) who present with symptoms related to their primary tumor. However, the survival benefit of PTR for asymptomatic patients is controversial. We investigated the change in PTR rates and the contribution of PTR to survival in patients with unresectable stage IV CRC over the past two decades in the United States. Clinicopathological factors and long-term survival were compared for 44 514 patients diagnosed with unresectable stage IV CRC from January 1, 1988, through December 31, 2010, who had or had not undergone PTR. Multivariable Cox regression and the instrumental variable method were used to identify independent factors for survival. Of the 44 514 patients with unresectable stage IV CRC, 27 931 (62.7%) had undergone PTR. The annual rate of PTR decreased from 74.4% to 50.2% diagnosed in 1988 and 2010, and the median overall survival increased for both PTR and non-PTR patients. Instrumental variable analyses revealed that PTR was associated with better overall, cancer-specific, and other-cause survival of patients with unresectable stage IV CRC.
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Zuguang
authors.initials: Z
authors.lastname: Xia
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Jia
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Chen
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Dapeng
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Min
authors.initials: M
authors.lastname: Tao
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.|Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.|Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Yixiang
authors.initials: Y
authors.lastname: Mao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D018426:SEER Program / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult