A Meta-Analysis to Determine the Effect of Primary Tumor Resection for Stage IV Colorectal Cancer with Unresectable Metastases on Patient Survival

Background

Approximately 20 % of patients diagnosed with colorectal cancer will have distant metastases at first presentation (stage IV disease). The effect of removing the primary tumor on survival for patients with stage IV disease with unresectable metastases remains unclear. To address this a meta-analysis of all studies comparing primary tumor resection with chemotherapy alone in cases of stage IV colorectal cancer with unresectable metastases was performed.

Methods

A comprehensive search for published studies examining the effect of primary tumor resection in the setting of colorectal cancer with unresectable metastases was performed. Each study was reviewed and data extracted. Random-effects methods were used to combine data.

Results

There were 21 studies including a total of 44,226 patients that met the inclusion criteria. Resection of the primary tumor in patients with unresectable metastases compared with chemotherapy alone was associated with a lower mortality risk (OR 0.28; 95 % CI 0.165–0.474; P < 0.001), translating into a difference in mean survival of 6.4 months in favor of resection (95 % CI 5.025–7.858, P < 0.001). Patients who underwent resection of the primary tumor were more likely to have liver metastasis only (OR 1.551; 95 % CI 1.247–1.929; P < 0.001), were less likely to have ≥2 metastasis (OR 0.653; 95 % CI 0.508–0.839; P = 0.001), and were less likely to have rectal cancer (OR 0.495; 95 % CI 0.390–0.629; P < 0.001). There was significant cross-study heterogeneity.

Conclusions

Resection of the primary tumor may confer a survival advantage in stage IV colorectal cancer with unresectable metastases but significant selection bias exists in current studies. Randomized controlled trials are essential to validate these findings.     

Impact of MammaPrint on Clinical Decision‐Making in South African Patients with Early‐Stage Breast Cancer

The aim of the study was to evaluate the impact of MammaPrint on treatment decision‐making in patients with breast cancer. Clinicopathologic information of all breast cancer patients referred for MammaPrint testing in South Africa was collected from 2007 until 2014. A total of 107 patients (109 tumors) with estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor‐2 negative tumors were selected with tumors ≥10 mm, or when 1–3 nodes were involved without extra‐nodal extension. None of the clinical indicators correlated significantly with the MammaPrint risk classification, which changed the decision for adjuvant chemotherapy in 52% of patients. Of 60 patients who were clinically high risk, 62% had a low‐risk MammaPrint result and of the 47 clinically low ‐risk patients 40% had a high‐risk MammaPrint result. This study indicates that MammaPrint could reduce the need for adjuvant chemotherapy by 17% using the selection criteria stipulated. The significant impact on treatment decisions confirmed the clinical utility of MammaPrint independent of standard clinicopathologic risk factors as supported by long‐term clinical outcome studies.     

Mycotic Common Iliac Artery Aneurysm Complicating Methicillin-Resistant Staphylococcus aureus Bacteremia: An Unusual Cause of Ureteric Obstruction

A 60-year-old man presented with ureteric obstruction secondary to a mycotic right common iliac artery aneurysm complicating methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The diagnosis of MRSA was not known at the time of surgery, and in situ replacement of the aneurysm using a rifampicin-bonded prosthesis was performed. The patient made a full recovery, and to date there is no evidence of residual or recurrent infection. To our knowledge, this is the first reported case of mycotic iliac aneurysm infected with MRSA in the literature. We discuss the consequences and the considerable diagnostic and therapeutic problems that arise. Presented at the Fifty-third International Congress of the European Society for Cardiovascular Surgery, Ljubljana, Slovenia, June 2-5, 2004.     

A new CT method for measuring cup orientation after total hip arthroplasty

Background It is difficult to assess the orientation of the acetabular component on routine radiographs. We present a method for determining the spatial orientation of the acetabular component after total hip arthroplasty (THA) using computed tomography.

Patients and methods Two CT-scans, 10 min apart, were obtained from each of 10 patients after THA. Using locally developed software, two independent examiners measured the orientation of the acetabular component in relation to the pelvis. The measurements were repeated after one week. To be independent of the patient position during scanning, the method involved two steps. Firstly, a 3D volumetric image of the pelvis was brought into a standard pelvic orientation, then the orientation of the acetabular component was measured. The orientation of the acetabular component was expressed as operative anteversion and inclination relative to an internal pelvic reference coordinate system. To evaluate precision, we compared measurements across pairs of CT volumes between observers and trials.

Results Mean absolute interobserver angle error was 2.3° for anteversion (range 0-6.6°), and 1.1° for inclination (range 0-4.6°). For interobserver measurements, the precision, defined as one standard deviation, was 2.9° for anteversion, and 1.5° for inclination. A Student's t-test showed that the overall differences between the examiners, trials, and cases were not significant. Data were normally distributed and were not dependent on examiner or trial.

Interpretation We conclude that the implant angles of the acetabular component in relation to the pelvis could be detected repeatedly using CT, independently of patient positioning.     

Cancer Incidence among a Cohort of Female Farm Residents in New York State

A retrospective cohort study of cancer incidence among 6,310 female farm residents who were New York Farm Bureau members, or members' spouses or relatives, was conducted from 1980 through 1993. Similar to the previous findings for New York State male farmers, the female farm resident cohort experienced significantly lower cancer rates for all cancers combined, and for lung cancer, compared with rural nonfarm female residents. In addition, significantly low rates for colorectal cancer and ovarian cancer were found among the female cohort members. Nonsignificant excesses were found for thyroid and liver cancers. The findings suggest that female farm residents in this cohort might have experienced some of the same cancer-protective factors as male farmers.