Ann Coloproctol.  2014 Aug;30(4):175-181. 10.3393/ac.2014.30.4.175.

Prognostic Implications of Primary Tumor Resection in Stage IVB Colorectal Cancer in Elderly Patients

• Ahn HJ
• Oh HS
• Ahn Y
• Lee SJ
• Kim HJ
• Kim MH
• Eom DW
• Kwak JY
• Han MS
• Song JS

• KMID: 2169740
• DOI: http://doi.org/10.3393/ac.2014.30.4.175

Abstract

PURPOSE
The aim of this study was to identify prognostic factors in stage IVB colorectal cancer in elderly patients, focusing on the influence of treatment modalities, including palliative chemotherapy and primary tumor resection.
METHODS
A cohort of 64 patients aged over 65 years who presented with stage IVB colorectal cancer at the Gangneung Asan Hospital between July 1, 2001, and December 31, 2009, was analyzed. Demographics, tumor location, tumor grade, performance status, levels of carcinoembryonic antigen (CEA), level of aspartate aminotransferase (AST), and distant metastatic site at diagnosis were analyzed. Using the treatment histories, we analyzed the prognostic implications of palliative chemotherapy and surgical resection of the primary tumor retrospectively.
RESULTS
The cohort consisted of 30 male (46.9%) and 34 female patients (53.1%); the median age was 76.5 years. Primary tumor resection was done on 28 patients (43.8%); 36 patients (56.2%) were categorized in the nonresection group. The median survival times were 12.43 months in the resection group and 3.58 months in the nonresection group (P < 0.001). Gender, level of CEA, level of AST, Eastern Cooperative Oncology Group performance status, tumor location, and presence of liver metastasis also showed significant differences in overall survival. On multivariate analysis, male gender, higher level of CEA, higher AST level, and no primary tumor resection were independent poor prognostic factors. In particular, nonresection of the primary tumor was the most potent/poor prognostic factor in the elderly-patient study group (P = 0.001; 95% confidence interval, 2.33 to 21.99; hazard ratio, 7.16).
CONCLUSION
In stage IVB colorectal cancer in elderly patients, resection of the primary tumor may enhance survival.

Keyword

Colorectal neoplasms; Prognosis; Palliative surgery

MeSH Terms

Aged*
Aspartate Aminotransferases
Carcinoembryonic Antigen
Chungcheongnam-do
Cohort Studies
Colorectal Neoplasms*
Demography
Diagnosis
Drug Therapy
Female
Gangwon-do
Humans
Liver
Male
Multivariate Analysis
Neoplasm Metastasis
Palliative Care
Prognosis
Retrospective Studies
Aspartate Aminotransferases
Carcinoembryonic Antigen