Prognostic Study Of Surgery On Stage Ⅳ Colorectal Cancer Based On The SEER Database

Objective:We aimed to explore the prognostic value of primary tumor and specific metastases excision on survival among patients with stage IV colorectal cancer(CRC)registered within the SEER database.Methods: Based on the SEER database of the National Cancer Institute of the United States,the clinical data of patients with advanced colon cancer who underwent surgery from 2010 to 2013 were retrospectively analyzed.Patients with IV stage colon cancer were divided into four groups according to the site of metastasis(liver,lung,bone,brain and multiple organs).Chi-square test was used to compare the clinicopathological features of different metastatic sites,and many research variables such as age,sex,and race were analyzed.Survival rate was calculated according to the Kaplan-Meier method,and differences between curves were tested by the log-rank test.Cox proportional hazards model were used in the multivariable analysis.Results:In total,there are 27,878 patients with distant metastases CRC were included into this study.Among the single organ site of metastatic colorectal cancer,patients with solitary metastasis of lung showed the highest median overall survival.While surgical remove for the metastases sites with liver and lung had better median OS compared with non-surgical patients(P<0.001).Both primary and metastatic sites surgical resection for the patients with liver,lung,and multiple metastases had better median OS compared with other treatment(P<0.001).We found that age younger than 65 years,Asian and Pacific Islander,distal colon and rectum,palliative primary tumor and metastatic lesions resection were associated with better OS after multivariate analysis.Palliative primary tumor and metastatic lesions resection had a significant survival benefit compared with non-surgical group in selected patients.Conclusion:Compared with non-operative treatment,most of the patients with stage IV CRC who received resection of primary tumor and metastatic site gained survival benefit,but no significant survival benefit was found in primary site resection of brain metastasis and resection of metastatic site of bone metastasis.Based on the analysis of the SEER database,our data support active surgical intervention in highly selected patients with metastatic CRC.