Abstract
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.
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Acknowledgments
The authors wish to thank Cheng-Hwai Tzeng and Dr. Po-Min Chen for help in discussions regarding the data.
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The authors have no conflicts of interest to disclose.
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Jen-Kou Lin and Lin-Kun Lee contributed equally to this study.
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.
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Lin, JK., Lee, LK., Chen, WS. et al. Concurrent Chemoradiotherapy Followed by Metastasectomy Converts to Survival Benefit in Stage IV Rectum Cancer. J Gastrointest Surg 16, 1888–1896 (2012). https://doi.org/10.1007/s11605-012-1959-6
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DOI: https://doi.org/10.1007/s11605-012-1959-6