A recent study by MD Anderson Cancer Center researchers has found that even though patients with advanced colorectal cancer (CRC) undergo less surgery, survival rates continue to improve, suggesting that primary tumor resection may be overused.
In the study entitled “Time Trend Analysis of Primary Tumor Resection for Stage IV Colorectal Cancer, Less Surgery, Improved Survival”, recently published in JAMA Surgery, the research team evaluated the secular patterns of primary tumor resection used in a total of 64,517 patients with stage IV Colorectal Cancer. Data was retrieved from the National Cancer Institute’s Surveillance, Epidemiology, and End Results CRC registry.
Of the total number of patients considered in the study, 67.4% had undergone primary tumor resection. In terms of annual rate of primary tumor resection, the researchers found a decrease from 74.5% in 1988 to 57.4% in 2010, with a significant annual percentage change between 1998-2001 and 2001-2010. Additionally, the results showed an improvement in the median survival rate, from 8.6% in 1988 to 17.8% in 2009, and an annual percentage change from 2.18% between 1988 and 2001 to 5.43% between 1996 and 2009. Thus, with effective chemotherapeutic and biologic agents, primary tumor resection in advanced CRC may not be necessary in all cases.
In a recent news release George Chang, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston and the study’s corresponding author, stated “We know from a previous phase II, cooperative group study that it’s safe to give chemotherapy even with biologics to patients with metastatic disease. Yet there’s still controversy about the role of primary tumor resection because some believe that there’s a survival association. The purpose of our study was to evaluate the use of primary tumor resection among patients with metastatic colorectal cancer in everyday practice and nationally by examining trends in the proportion of metastatic patients undergoing PTR.”
He further added, “Our findings tell us that it is increasingly recognized that chemotherapy may be safely given to patients with tumors intact. Although fewer people are getting primary tumors resected, a large proportion of patients with metastatic disease at diagnosis are still having them removed. Together with the observation that primary tumor resection was more likely performed in younger patients who have colon rather than rectal cancers suggests that there may still be an overutilization of PTR and that careful consideration of the indication for such surgery should be made.”