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Background <p>The optimal management of colon cancer patients with unresectable liver-only metastases remains controversial. This study aimed to evaluate whether primary tumor resection confers a survival benefit in this population using data extracted from the Surveillance, Epidemiology, and End Results (SEER) database.</p> Methods <p>We identified patients diagnosed with colon cancer between 2018 and 2020 in the SEER database. After excluding those with extrahepatic metastases, multiple primary malignancies, or resectable liver lesions, a total of 1,533 patients with unresectable liver-only metastases were included. Among them, 400 underwent primary tumor resection and 1,133 did not. To reduce selection bias, propensity score matching (PSM) was performed, yielding two well-balanced cohorts of 167 patients each. Kaplan-Meier analysis was used to estimate overall survival (OS) and cancer-specific survival (CSS). Multivariable Cox proportional hazards regression determined independent prognostic factors, while logistic regression identified factors associated with receiving surgery.</p> Results <p>Before PSM, patients in the resection group were generally younger, had smaller tumors, and were more likely to receive chemotherapy than those without resection (all <i>p</i> &lt; 0.05). After matching, baseline characteristics were comparable between groups. Kaplan-Meier curves showed significantly improved OS and CSS for the surgical group at 12, 24, and 36 months (<i>p</i> &lt; 0.0001). In the multivariable Cox model, primary tumor resection independently predicted better CSS (HR = 0.409, 95% CI: 0.290–0.576, <i>p</i> &lt; 0.001). Logistic regression revealed that T stage was significantly associated with the likelihood of undergoing surgery (<i>p</i> &lt; 0.05).</p> Conclusions <p>Primary tumor resection in patients with colon cancer and unresectable liver-only metastases is independently associated with improved survival. These findings support considering surgical intervention of the primary tumor as part of a comprehensive treatment strategy, although prospective studies are warranted to confirm these results.</p>

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Primary tumor resection improves survival in colon cancer patients with unresectable liver only metastases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月17日

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  • Yunbin Ma,
  • Wenguo Yang,
  • Jialin Chen,
  • Xiaoli Chen,
  • Jianan Chen

摘要

Background

The optimal management of colon cancer patients with unresectable liver-only metastases remains controversial. This study aimed to evaluate whether primary tumor resection confers a survival benefit in this population using data extracted from the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

We identified patients diagnosed with colon cancer between 2018 and 2020 in the SEER database. After excluding those with extrahepatic metastases, multiple primary malignancies, or resectable liver lesions, a total of 1,533 patients with unresectable liver-only metastases were included. Among them, 400 underwent primary tumor resection and 1,133 did not. To reduce selection bias, propensity score matching (PSM) was performed, yielding two well-balanced cohorts of 167 patients each. Kaplan-Meier analysis was used to estimate overall survival (OS) and cancer-specific survival (CSS). Multivariable Cox proportional hazards regression determined independent prognostic factors, while logistic regression identified factors associated with receiving surgery.

Results

Before PSM, patients in the resection group were generally younger, had smaller tumors, and were more likely to receive chemotherapy than those without resection (all p < 0.05). After matching, baseline characteristics were comparable between groups. Kaplan-Meier curves showed significantly improved OS and CSS for the surgical group at 12, 24, and 36 months (p < 0.0001). In the multivariable Cox model, primary tumor resection independently predicted better CSS (HR = 0.409, 95% CI: 0.290–0.576, p < 0.001). Logistic regression revealed that T stage was significantly associated with the likelihood of undergoing surgery (p < 0.05).

Conclusions

Primary tumor resection in patients with colon cancer and unresectable liver-only metastases is independently associated with improved survival. These findings support considering surgical intervention of the primary tumor as part of a comprehensive treatment strategy, although prospective studies are warranted to confirm these results.