Background/Aims: The molecular underpinnings of colorectal cancer (CRC) vary according to the tumor location. The advantages of a palliative primary tumor resection in patients with metastatic CRC are controversial. This study examined the survival outcomes of a palliative primary tumor resection based on the tumor location in patients with metastatic CRC. Methods: The medical records of 600 patients diagnosed with metastatic CRC between January 2000 and June 2018 were reviewed retrospectively. Patients undergoing surgery for both the primary tumor and metastatic lesions were excluded. The clinical factors affecting the long-term outcomes were evaluated according to the primary tumor location, and the long-term survival was compared between patients with and without a palliative primary tumor resection. The data were analyzed using the Kaplan-Meier estimator and multivariate Cox regression models. Results: The median follow-up duration was 18 months (interquartile range, 10-28). Patients with right-sided CRC had a poor overall- and progression-free survival compared to those with left-sided CRC. In multivariate Cox regression analysis, the palliative primary tumor resection was an independent prognostic factor predicting better overall survival in patients with metastatic CRC, regardless of the primary tumor location. Conclusions The primary tumor location influences the prognosis, and that a primary tumor resection can improve the overall survival in patients with metastatic CRC, regardless of the primary tumor location.

BACKGROUND AND OBJECTIVE: In dialysis patients, the cardiovascular mortality is 10 to 20 times higher than that in the general population. The increased arterial stiffness in patients with end-stage renal disease (ESRD) is an independent predictor of all-cause mortality. The arterial stiffness and atherosclerotic markers were evaluated in patients with ESRD treated with and without hemodialysis (HD) or peritoneal dialysis (PD). SUCJECTS AND METHODS: 14 hemodialysis (mean dialysis duration 19.6 months), 14 peritoneal dialysis (mean dialysis duration 26.1 months) and 14 patients with ESRD prior to initiation of dialysis, and 27 age-sex matched controls were enrolled. The calculated central pulse pressure, plasma homocysteine, serum C-reactive protein, left ventricular mass index and aortic pulse wave velocity (PWV) were measured. RESULTS: Patients with ESRD treated with and without dialysis had greater increases in their arterial stiffness and advanced atherosclerosis compared with the controls. However, there was no difference in the arterial stiffness and atherosclerotic markers before and after the dialysis treatment, or in the dialysis modality (HD, PD) of patients with ESRD. In a multiple regression model, PWV in patients with ESRD was explained by the level of plasma homocysteine (beta=0.396;p=0.027). CONCLUSION: Atherosclerosis and arterial stiffness in patients with ESRD may not be affected by dialysis treatment or modality. In patients with ESRD, the level of plasma homocysteine is independently associated with arterial stiffness.
Atherosclerosis ; Blood Pressure ; C-Reactive Protein ; Dialysis* ; Homocysteine ; Humans ; Kidney Failure, Chronic* ; Mortality ; Peritoneal Dialysis ; Plasma ; Pulse Wave Analysis ; Renal Dialysis ; Renal Insufficiency ; Vascular Stiffness*