Aa, D.C. van der (2021) Is there a role for surgery in patients with few or absent symptoms of stage IV colorectal cancer with unresectable metastases? thesis, Medicine.
Full text available on request.Abstract
Background The colorectal cancer incidence is increasing. In the past decades, it is responsible for approximately one-tenth of cancer-related mortality worldwide. Fortunately, the implementation of nationwide screening programmes has resulted in a decrease in mortality. However about a quarter of the patients has asymptomatic or minimally symptomatic metastatic disease at diagnoses and more than 75% of these patients have unresectable disease. There is no consensus yet on the best strategy. Should these patients undergo primary surgery followed by chemotherapy or start with chemotherapy first as palliative treatment? Methods This retrospective cohort study based in OLVG Hospital Amsterdam includes patients who are treated between 1997 and 2014 with unresectable stage IV colorectal cancer with few or absent symptoms. The data was extracted from Epic and General Practitioners were contacted. Two hundred nineteen patients were included. Data analysis with SPSS (IBM, Chicago, Illinois, version 22) was applied to question differences in overall survival (OS) between the two intervention groups and best supportive care group, added as control group. All patients had complete follow-up. Results Univariable analysis showed no benefit in OS between the two strategies in the intention-to�treat group ((n=177) 75.7(±7.5) weeks vs. 79.1(±8.6) weeks (p= 0.964)) and in the finished treatment (>6 cycles chemotherapy) group ((n=105) 112.4 (±16.5) weeks vs. 85.9 (±8.3) weeks (p= 0.165)). Multivariable analysis found that primary tumour in the transverse colon (Hazard Ratio (HR)=4.04 [95% Confidence Interval (CI) =1.90-8.58] (p= <0.001)), two or more metastases (HR=1.78 [95% CI =1.23-2.59] (p= 0.002)), and finishing chemotherapy (HR = 0.39 [95% CI =0.26-0.58] (p= <0.001)) were independent factors associated with OS. Conclusion There is no significant difference in OS between surgery first followed by chemotherapy or chemotherapy first in minimally symptomatic or asymptomatic patients with stage IV colorectal cancer. Finishing chemotherapy is an important factor for OS.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Castro, S.M.M. de and Faneyte, I.F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 06 Jan 2022 08:36 |
| Last Modified: | 06 Jan 2022 08:36 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2957 |
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