Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: A multivariate analysis

Background: The prognostic impact of primary tumor resection in patients presenting with unresectable synchronous metastases from colorectal carcinoma (CRC) is not well established. In the present study, we analyzed fifteen factors to define the value of primary tumor resection with regard to prognosis. Patients and Methods: We identified 186 consecutive patients with proven stage IV CRC from the year 1995 to 2001. Variables were tested for their relationship to survival in univariate analyses with the Kaplan-Meier method and the log rank test. Factors that showed a significant impact were included in a Cox proportional hazards model. The tests were repeated for 107 patients who had no symptoms from their primary tumor. Results: Overall there were six independent variables with a relationship to survival: performance status, ASA-class, CEA level, metastatic load, extent of primary tumor, and chemotherapy. In the asymptomatic patients we investigated 13 factors, 3 of which proved to be independent predictors of survival: performance status, CEA level, and chemotherapy. Resection of primary tumor was only predictive of survival if in-hospital mortality was excluded. Conclusion: Resection of the tumor, if possible, is doubtless the best option for stage IV CRC patients with severe symptoms caused by their primary tumor. In asymptomatic patients, chemotherapy is preferable to surgery. (C) 2005 Wiley-Liss, Inc.