Cited 2 times since 2020 (0.5 per year) source: EuropePMC European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, Volume 46, Issue 6, 29 5 2020, Pages 1167-1173 Treatment strategies and overall survival for incurable metastatic colorectal cancer - A EURECCA international comparison including 21,196 patients from the Netherlands and Norway. Breugom AJ, Bastiaannet E, Guren MG, Kørner H, Boelens PG, Dekker FW, Kapiteijn E, Gelderblom H, Larsen IK, Liefers GJ, van de Velde CJH
Background
The potential benefit of surgery of the primary tumour in patients with asymptomatic metastatic colorectal cancer is debated. This EURECCA international comparison analyses treatment strategies and overall survival in the Netherlands and Norway in patients with incurable metastatic colorectal cancer.
Methods
National cohorts (2007-2013) from the Netherlands and Norway including all patients with synchronous metastatic colorectal cancer were compared on treatment strategy and overall survival. Using country as an instrumental variable, we assessed the effect of different treatment strategies on mortality in the first year.
Results
Of 21,196 patients (16,144 Dutch and 5052 Norwegian), 38.6% Dutch and 51.5% (p < 0.001) Norwegian patients underwent resection of the primary tumour. In the Netherlands, 58.2% received chemotherapy compared with 21.4% in Norway. Radiotherapy was given in 9.5% of Dutch patients and 7.2% of Norwegian patients. Using the Netherlands as reference, the adjusted HR for overall survival was 0.96 (95% CI 0.93-0.99; p = 0.024). Instrumental variable analysis showed an adjusted OR of 1.00 (95% CI 0.99-1.02; p = 0.741).
Conclusions
Treatment strategies varied significantly between the Netherlands and Norway, with more surgery and less radiotherapy in Norway. Adjusted overall survival was better in Norway for all patients and patients <75 years, but not for patients ≥75 years. Instrumental variable analysis showed no benefit in one-year mortality for a treatment strategy with a higher proportion of surgery and a lower proportion of radiotherapy. Our findings emphasise the need for further research to select patients with incurable metastatic colorectal cancer for different treatment options.
