Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: Individual patient data analysis of first-line randomised trials from the ARCAD database

摘要

Abstract Indication for primary tumour resection (PTR) in asymptomatic metastatic colorectal cancer (mCRC) patients is unclear. Previous retrospective analyses suggest a survival benefit for patients who underwent PTR. The aim was to evaluate the prognostic value of PTR in patients with synchronous mCRC by analysis of recent large RCTs including systemic therapy with modern targeted agents. Individual patient data (IPD) of 3423 patients enrolled into 8 randomised controlled trials (RCTs) with first-line systemic therapy in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were analysed. The number of patients with unresected synchronous mCRC, resected synchronous mCRC and metachronous mCRC was 710 (21%), 1705 (50%) and 1008 (29%), respectively. Adjusting for age, gender, performance status (PS) and prior chemotherapy, the unresected group had a significantly worse median overall survival?(16.4?m) compared with the synchronous resected (22.2?m; hazard ratio [HR] 1.60, 95% CI 1.43–1.78) and metachronous (22.4?m; HR 1.81, 95% CI 1.58–2.07) groups. Similarly, median progression-free survival?was significantly worse for the unresected group compared with the synchronous resected (HR 1.31, 95% CI 1.19–1.44) and metachronous (HR 1.47, 95% CI 1.30–1.66) groups. In a multivariate analysis, the observed associations remained significant. This largest IPD analysis of mCRC trials to date demonstrates an improved survival in synchronous mCRC patients after PTR. These results may be subject to bias since reasons for (non)resection were not available. Until results of ongoing RCTs are available, both upfront PTR followed by systemic treatment and upfront systemic treatment are considered appropriate treatment strategies. Highlights ? Data of RCTs regarding primary tumour resection (PTR) in synchronous metastatic colorectal cancer (mCRC) are lacking. ? All patients in this analysis of 8 large mCRC trials in the ARCAD database received modern systemic treatment including targeted agents. ? Synchronous mCRC patients with upfront PTR have a significant improved survival of almost 6 months compared to unresected mCRC patients. ? Results of ongoing RCTs are warranted to obtain a definitive conclusion about the survival benefit of PTR in synchronous mCRC.