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Patients with advanced colon cancer having less surgery, better survival

The JAMA Network Journals

The annual rate of primary tumor removal for advanced stage IV colorectal cancer (CRC) has decreased since 1988 and the trend toward nonsurgical management of the disease noted in 2001 coincides with the availability of newer chemotherapy and biologic treatments, according to a report published online by JAMA Surgery.

CRC is the third most commonly diagnosed cancer and the third leading cause of cancer death in men and women in the United States. About 20 percent of patients are diagnosed with stage IV disease and their reported five-year relative survival rate is 12.5 percent, according to background information in the study.

Chung-Yuan Hu, M.P.H., Ph.D., of the University of Texas MD Anderson Center, Houston, and coauthors examined patterns of primary tumor resection (PTR) and survival in stage IV CRC in the United States. The authors analyzed data from the National Cancer Institute's Surveillance, Epidemiology and End Results CRC registry. Their study included data on 64,157 patients diagnosed with stage IV colon or rectal cancer from 1988 through 2010, including those who underwent PTR and those who did not.

Overall, 67.4 percent of patients (43,273 of 64,157) had PTR, according to the study results. The annual rate of PTR decreased from 74.5 percent in 1988 to 57.4 percent in 2010, with a significant annual percentage change occurring between 1998-2001 and 2001-2010. Patients undergoing PTR tended to be younger than 50 years old, female, married, have a higher tumor grade and have colon tumors. Results also show the median survival rate for stage IV CRC improved from 8.6 percent in 1988 to 17.8 percent in 2009.

The authors acknowledge limitations of their study, including that the decreasing rate of PTR could have primarily been the result of more effective systemic therapy or of greater reluctance by surgeons to operate on patients with asymptomatic stage IV CRC.

"Despite the availability of more effective chemotherapeutic options, a considerable number of patients with stage IV CRC continue to undergo PTR. Our findings indicate potential overuse of PTR among these patients and highlight a need to better understand the clinical decisions and outcomes associated with that treatment," the authors conclude.

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(JAMA Surgery. Published online January 14, 2015. doi:10.1001/jamasurg.2014.2253. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: This work was supported in part by grants from the National Institutes of Health/National Cancer Institute and an American Society of Clinical Oncology Foundation Career Development Award. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact corresponding author George J. Chang, M.D., M.S., call Laura Sussman at 713-745-2457 or email lsussman@mdanderson.org.

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