TY - JOUR
T1 - Concurrent Chemoradiotherapy Followed by Metastasectomy Converts to Survival Benefit in Stage IV Rectum Cancer
AU - Lin, Jen Kou
AU - Lee, Lin Kun
AU - Chen, Wei Shone
AU - Lin, Tzu Chen
AU - Jiang, Jeng Kai
AU - Yang, Shung Haur
AU - Wang, Huann Sheng
AU - Chang, Shih Ching
AU - Lan, Yuan Tzu
AU - Lin, Chun Chi
AU - Yen, Chueh Chuan
AU - Liu, Jin Hwang
AU - Tzeng, Cheng Hwai
AU - Teng, Hao Wei
N1 - Funding Information:
Grant support: The Division of Experimental Surgery of the Department of Surgery, Taipei Veterans General Hospital and by the Taipei Veterans General Hospital, Taiwan Clinical Oncology Research Foundation, Department of Health, Taiwan. L.-K.Lee.C.-C.Yen.J.-H.Liu.C.-H.Tzeng.H.-W.Teng(*) Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan e-mail: [email protected]
PY - 2012/9
Y1 - 2012/9
N2 - 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.
AB - 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.
KW - Colorectal cancer
KW - Metastases
KW - Propensity score model
KW - Radiation
UR - http://www.scopus.com/inward/record.url?scp=84866544544&partnerID=8YFLogxK
U2 - 10.1007/s11605-012-1959-6
DO - 10.1007/s11605-012-1959-6
M3 - Article
C2 - 22833439
AN - SCOPUS:84866544544
SN - 1091-255X
VL - 16
SP - 1888
EP - 1896
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 10
ER -
