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Study Finds Decreasing Rates of Primary Tumor Resection and Better Survival Among Patients With Advanced Colorectal Cancer

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Key Points

  • Overall, 67.4% of patients diagnosed with stage IV colon or rectal cancer from 1988 through 2010 had primary tumor resection.
  • The annual rate of primary tumor resection decreased from 74.5% in 1988 to 57.4% in 2010, with a significant annual percentage change occurring from 1998 to 2001 and 2001 to 2010.
  • The median survival rate for stage IV colorectal cancer improved from 8.6% in 1988 to 17.8% in 2009.

The annual rate of primary tumor removal for stage IV colorectal cancer has decreased since 1988, and the trend toward nonsurgical management of the disease noted in 2001 coincides with the availability of newer chemotherapy and biologic treatments, according to study reported by Hu et al in JAMA Surgery.

Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in men and women in the United States. About 20% of patients are diagnosed with stage IV disease, and their reported 5-year relative survival rate is 12.5%. 

Study Details

In the current study, Chung-Yuan Hu, MPH, PhD, of The University of Texas MD Anderson Center, Houston, and colleagues examined patterns of primary tumor resection and survival in stage IV colorectal cancer in the United States. The authors analyzed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results colorectal cancer registry. Their study included data on 64,157 patients diagnosed with stage IV colon or rectal cancer from 1988 through 2010, including those who underwent primary tumor resection and those who did not.

Overall, 67.4% of patients (43,273 of 64,157) had primary tumor resection, according to the study results. The annual rate of primary tumor resection decreased from 74.5% in 1988 to 57.4% in 2010, with a significant annual percentage change occurring from 1998 to 2001 and 2001 to 2010. Patients undergoing primary tumor resection tended to be younger than 50 years old, female, married, have a higher tumor grade and have colon tumors. Results also show the median survival rate for stage IV colorectal cancer improved from 8.6% in 1988 to 17.8% in 2009.

Study Limitations

The authors acknowledge limitations of their study, including that the decreasing rate of primary tumor resection could have primarily been the result of more effective systemic therapy or of greater reluctance by surgeons to operate on patients with asymptomatic stage IV colorectal cancer. 

“Despite the availability of more effective chemotherapeutic options, a considerable number of patients with stage IV [colorectal cancer] continue to undergo [primary tumor resection]. Our findings indicate potential overuse of [primary tumor resection] among these patients and highlight a need to better understand the clinical decisions and outcomes associated with that treatment,” the authors concluded.

George J. Chang, MD, MS, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Surgery article.

The study was supported in part by grants from the National Institutes of Health/National Cancer Institute and an American Society of Clinical Oncology Foundation Career Development Award.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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