Researchers led by Chung-Yuan Hu, M.P.H., Ph.D., of the University of Texas MD Anderson Center, Houston, examined patterns of primary tumor resection (surgery) and survival in stage IV colorectal cancer in the United States. Their study appears today in the journal JAMA Surgery.
The authors analyzed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) 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 surgery and those who did not.
Overall, 67.4 percent of patients (43,273 of 64,157) had surgery during the study period, however the rate of surgery dropped from 74.5 percent in 1988 to 57.4 percent in 2010. Results also show the median survival rate for stage IV CRC nearly doubled from 8.6 percent in 1988 to 17.8 percent in 2009.
The results prompted the researchers to question why so many patients continue to be treated with surgery.
“Despite the availability of more effective chemotherapeutic options, a considerable number of patients with stage IV CRC continue to undergo PTR (surgery)," the authors wrote. "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.
The authors acknowledge limitations of their study, including that the decreasing rate of surgery 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.
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