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The influence of local therapy on the survival of patients with metastatic rectal cancer: a population-based, propensity-matched study

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This study was aimed to determine the effect of the local tumor therapy on patients’ prognosis in the management of metastatic rectal cancer.

Methods

Patients diagnosed with metastatic rectal cancer from 2004 to 2013 were selected from the SEER (Surveillance, Epidemiology, and End Results) database. Overall survival and cancer-specific survival were compared between the local treatment group and the nonlocal treatment group using Kaplan–Meier methods. Uni- and multivariate analyses were further performed to confirm or deny the results. The statistical approach of propensity score matching was conducted to avoid potential confounding factors.

Results

Of 6867 patients included in this analysis, 3971 (57.8%) received local therapy to the primary tumor and 2896 (42.2%) did not receive. Both univariable and multivariable analysis showed local therapy continued to be associated with an improvement in OS (HR 0.532; 95% CI 0.503–0.563, p < 0.001 and HR 0.532; 95% CI 0.498–0.568, p < 0.001, respectively) and CSS (HR 0.527; 95% CI 0.497–0.559, p < 0.001 and HR 0.521; 95% CI 0.487–0.557, p < 0.001, respectively) in the unmatched cohorts. Further analysis showed patients underwent local tumor destruction or surgical resection had a better overall survival compared with those who did not undergo (p < 0.001). In the matched population, patients receiving local therapy had a better OS (HR 0.427; 95% CI 0.428–0.519, p < 0.001) and CSS (HR 0.462; 95% CI 0.418–0.511, p < 0.001) compared with those who did not receive.

Conclusions

Local therapy to the primary tumor may be associated with a better survival in patients with metastatic rectal cancer.

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Abbreviations

SEER:

Surveillance, Epidemiology, and End Results

mRC:

Metastatic rectal cancer

OS:

Overall survival

CSS:

Cancer-specific survival

HR:

Hazard ratio

PSM:

Propensity score matching

PTR:

Primary tumor resection

SPSS:

Statistical package for the social sciences

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Acknowledgements

The authors acknowledge the efforts of the SEER program in the creation of the SEER database.

Author information

Author notes

  1. Chi-Hao Zhang, Yuan-Bo Pan, Qing-Wei Zhang and Ou-Min Shi authors have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China

    Chi-Hao Zhang, Lei Zheng & Liang Gui

  2. Department of Neurosurgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China

    Yuan-Bo Pan

  3. Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China

    Qing-Wei Zhang

  4. The Second Affiliated Hospital of Shenzhen University, Shenzhen, 518000, China

    Ou-Min Shi

  5. Department of General Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, 200001, Shanghai, China

    Meng Luo

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  1. Chi-Hao Zhang
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Corresponding author

Correspondence to Meng Luo.

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Conflict of interest

The authors declare no conflicts of interest.

Funding

This study was not funded.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed content

As personal identifying information was not included in the SEER database and thus, the informed consent was not required in this study.

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Zhang, CH., Pan, YB., Zhang, QW. et al. The influence of local therapy on the survival of patients with metastatic rectal cancer: a population-based, propensity-matched study. J Cancer Res Clin Oncol 143, 1891–1903 (2017). https://doi.org/10.1007/s00432-017-2442-2

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  • DOI: https://doi.org/10.1007/s00432-017-2442-2

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