Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy: Results from the multicenter, randomised trial Fédération Francophone de Cancérologie Digestive 9601

F. Ferrand, D. Malka, A. Bourredjem, C. Allonier, O. Bouché, S. Louafi, V. Boige, M. Mousseau, J. L. Raoul, L. Bedenne, B. Leduc, P. Deguiral, M. Faron, J. P. Pignon, M. Ducreux

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Abstract

Objective: To assess the impact of primary tumour resection on overall survival (OS) of patients diagnosed with stage IV colorectal cancer (CRC). Design: Among the 294 patients with non-resectable colorectal metastases enrolled in the Fédération Francophone de Cancérologie Digestive (FFCD) 9601 phase III trial, which compared different first-line single-agent chemotherapy regimens, 216 patients (73%) presented with synchronous metastases at study entry and constituted the present study population. Potential baseline prognostic variables including prior primary tumour resection were assessed by univariate and multivariate Cox analyses. Progression-free survival (PFS) and OS curves were compared with the logrank test. Results: Among the 216 patients with stage IV CRC (median follow-up, 33 months), 156 patients (72%) had undergone resection of their primary tumour prior to study entry. The resection and non-resection groups did not differ for baseline characteristics except for primary tumour location (rectum, 14% versus 35%; p = 0.0006). In multivariate analysis, resection of the primary was the strongest independent prognostic factor for PFS (hazard ratio (HR), 0.5; 95% confidence interval [CI], 0.4-0.8; p = 0.0002) and OS (HR, 0.4; CI, 0.3-0.6; p < 0.0001). Both median PFS (5.1 [4.6-5.6] versus 2.9 [2.2-4.1] months; p = 0.001) and OS (16.3 [13.7-19.2] versus 9.6 [7.4-12.5]; p < 0.0001) were significantly higher in the resection group. These differences in patient survival were maintained after exclusion of patients with rectal primary (n = 43). Conclusion: Resection of the primary tumour may be associated with longer PFS and OS in patients with stage IV CRC starting first-line, single-agent chemotherapy.

Original languageEnglish
Pages (from-to)90-97
Number of pages8
JournalEuropean Journal of Cancer
Volume49
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Bibliographical note

Funding Information:
The FFCD 9601 trial was supported by a grant from Astra-Zeneca Pharmaceuticals and a grant from the Ligue Nationale Contre le Cancer. The authors declare no conflict of interest.

Keywords

  • Colorectal cancer
  • Metastases
  • Multivariate analysis
  • Primary tumour resection

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