Effect of surgical resection (SR) of primary tumor in advanced colorectal cancer (CRC) on outcome: A Canadian province’s experience
Bibliographic record
Abstract
15016 Background: Advances in anticancer therapy have led to improved outcomes for patients with advanced CRC. The potential benefit of SR of primary tumor in these patients remains unknown. We have recently demonstrated that SR of primary tumor in patients with newly diagnosed advanced CRC has been associated with survival benefit irrespective of chemotherapy (ASCO 2008 GI Symposium). We present here an update analysis. Methods: Medical records of patients with metastatic CRC diagnosed from 1992–2000 in Saskatchewan province were reviewed. Patients with unresectable T4M0 disease were excluded. A multivariate analysis was done using Cox regression model and various clinicopathologic variables were tested for their prognostic significance. Kaplan-Meier curves were used to determine survival. Results: A total 813 eligible patients were identified. Patients median age was 71 yrs (24–98) and M: F was 56:44. Five hundred-ninety four (73%) patients underwent SR of the primary tumor. Among 594 patients, 248 (41%) were operated for tumor related symptoms. Thirty-nine (6.5%) died within 30 days of surgery. Of 813 patients, 314 (39%) patients received 5FU-based chemotherapy and 84 (10%) received a second line therapy. Median overall survival (OS) of all patients was 7.3 months. Patients who received chemotherapy had a median OS of 14.8 months compared with 4.1 months if they did not receive chemotherapy (p<0.0001). Patients who underwent SR of primary tumor had a median OS of 9.7 months compared with 3.3 months in patients who did not have surgery (p<0.0001). Patients who had SR and received chemotherapy had a significantly better median OS of 16.7 months compared with 8.7 months if they received chemotherapy but did not have surgery (P<0.0001). On multivariate analysis 5FU-based chemotherapy (HR 0.48; 95% CI: 0.40–0.56), SR of primary tumor (HR 0.49; 95%CI: 0.42–0.59), and metastectomy (HR 0.58; 95% CI: 0.46–0.71) were correlated with a better survival in patients with advanced CRC. Conclusions: SR of primary tumor in patients with advanced CRC has been associated with significant improvement in survival independent of systemic chemotherapy. A future prospective trial is warranted to assess the role of SR of primary tumor in the era of targeted therapy. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".