Treating patients with colon cancer liver metastasis

A nationwide analysis of therapeutic decision making

Hari Nathan, John F. Bridges, David P. Cosgrove, Luis A. Diaz, Daniel A. Laheru, Joseph M. Herman, Richard D. Schulick, Barish H. Edil, Christopher L. Wolfgang, Michael A. Choti, Timothy M. Pawlik

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background. Criteria for resectability of colon cancer liver metastases (CLM) are evolving, yet little is known about how physicians choose a therapeutic strategy for potentially resectable CLM. Methods. Physicians completed a national Web-based survey that consisted of varied CLM conjoint tasks. Respondents chose among three treatment strategies: immediate liver resection (LR), preoperative chemotherapy followed by surgery (C → LR), or palliative chemotherapy (PC). Data were analyzed by multinomial logistic regression, yielding odds ratios (OR). Results. Of 219 respondents, 79 % practiced at academic centers and 63 % were in practice ≥10 years. Median number of cases evaluated was four per month. Surgical training varied: 51 % surgical oncology, 44 % hepatopancreato- biliary/transplantation, 5 % no fellowship. Although each factor affected the choice of CLM therapy, the relative effect differed. Hilar lymph node disease predicted a strong aversion to LR with surgeons more likely to choose C → LR (OR 8.92) or PC (OR 49.9). Solitary lung metastasis also deterred choice of LR, with respondents favoring C → LR (OR 4.43) or PC (OR 6.97). After controlling for clinical factors, surgeons with more years in practice were more likely to choose PC over C → LR (OR 1.94) (P = 0.005). Surgical oncology-trained surgeons were more likely than hepatobiliary/transplant-trained surgeons to choose C → LR (OR 2.53) or PC (OR 4.15) (P<0.001). Conclusions. This is the first nationwide study to define the relative impact of key clinical factors on choice of therapy for CLM. Although clinical factors influence choice of therapy, surgical subspeciality and physician experience are also important determinants of care.

Original languageEnglish (US)
Pages (from-to)3668-3676
Number of pages9
JournalAnnals of Surgical Oncology
Volume19
Issue number12
DOIs
StatePublished - Nov 2012

Fingerprint

Liver Neoplasms
Colonic Neoplasms
Decision Making
Odds Ratio
Neoplasm Metastasis
Liver
Drug Therapy
Therapeutics
Physicians
Transplantation
Logistic Models
Lymph Nodes
Transplants
Lung
Surveys and Questionnaires
Surgeons

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Nathan, H., Bridges, J. F., Cosgrove, D. P., Diaz, L. A., Laheru, D. A., Herman, J. M., ... Pawlik, T. M. (2012). Treating patients with colon cancer liver metastasis: A nationwide analysis of therapeutic decision making. Annals of Surgical Oncology, 19(12), 3668-3676. https://doi.org/10.1245/s10434-012-2564-3

Treating patients with colon cancer liver metastasis : A nationwide analysis of therapeutic decision making. / Nathan, Hari; Bridges, John F.; Cosgrove, David P.; Diaz, Luis A.; Laheru, Daniel A.; Herman, Joseph M.; Schulick, Richard D.; Edil, Barish H.; Wolfgang, Christopher L.; Choti, Michael A.; Pawlik, Timothy M.

In: Annals of Surgical Oncology, Vol. 19, No. 12, 11.2012, p. 3668-3676.

Research output: Contribution to journalArticle

Nathan, H, Bridges, JF, Cosgrove, DP, Diaz, LA, Laheru, DA, Herman, JM, Schulick, RD, Edil, BH, Wolfgang, CL, Choti, MA & Pawlik, TM 2012, 'Treating patients with colon cancer liver metastasis: A nationwide analysis of therapeutic decision making', Annals of Surgical Oncology, vol. 19, no. 12, pp. 3668-3676. https://doi.org/10.1245/s10434-012-2564-3
Nathan, Hari ; Bridges, John F. ; Cosgrove, David P. ; Diaz, Luis A. ; Laheru, Daniel A. ; Herman, Joseph M. ; Schulick, Richard D. ; Edil, Barish H. ; Wolfgang, Christopher L. ; Choti, Michael A. ; Pawlik, Timothy M. / Treating patients with colon cancer liver metastasis : A nationwide analysis of therapeutic decision making. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 12. pp. 3668-3676.
@article{50b6f7aeeec64a7fb5fc0958c832f058,
title = "Treating patients with colon cancer liver metastasis: A nationwide analysis of therapeutic decision making",
abstract = "Background. Criteria for resectability of colon cancer liver metastases (CLM) are evolving, yet little is known about how physicians choose a therapeutic strategy for potentially resectable CLM. Methods. Physicians completed a national Web-based survey that consisted of varied CLM conjoint tasks. Respondents chose among three treatment strategies: immediate liver resection (LR), preoperative chemotherapy followed by surgery (C → LR), or palliative chemotherapy (PC). Data were analyzed by multinomial logistic regression, yielding odds ratios (OR). Results. Of 219 respondents, 79 {\%} practiced at academic centers and 63 {\%} were in practice ≥10 years. Median number of cases evaluated was four per month. Surgical training varied: 51 {\%} surgical oncology, 44 {\%} hepatopancreato- biliary/transplantation, 5 {\%} no fellowship. Although each factor affected the choice of CLM therapy, the relative effect differed. Hilar lymph node disease predicted a strong aversion to LR with surgeons more likely to choose C → LR (OR 8.92) or PC (OR 49.9). Solitary lung metastasis also deterred choice of LR, with respondents favoring C → LR (OR 4.43) or PC (OR 6.97). After controlling for clinical factors, surgeons with more years in practice were more likely to choose PC over C → LR (OR 1.94) (P = 0.005). Surgical oncology-trained surgeons were more likely than hepatobiliary/transplant-trained surgeons to choose C → LR (OR 2.53) or PC (OR 4.15) (P<0.001). Conclusions. This is the first nationwide study to define the relative impact of key clinical factors on choice of therapy for CLM. Although clinical factors influence choice of therapy, surgical subspeciality and physician experience are also important determinants of care.",
author = "Hari Nathan and Bridges, {John F.} and Cosgrove, {David P.} and Diaz, {Luis A.} and Laheru, {Daniel A.} and Herman, {Joseph M.} and Schulick, {Richard D.} and Edil, {Barish H.} and Wolfgang, {Christopher L.} and Choti, {Michael A.} and Pawlik, {Timothy M.}",
year = "2012",
month = "11",
doi = "10.1245/s10434-012-2564-3",
language = "English (US)",
volume = "19",
pages = "3668--3676",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "12",

}

TY - JOUR

T1 - Treating patients with colon cancer liver metastasis

T2 - A nationwide analysis of therapeutic decision making

AU - Nathan, Hari

AU - Bridges, John F.

AU - Cosgrove, David P.

AU - Diaz, Luis A.

AU - Laheru, Daniel A.

AU - Herman, Joseph M.

AU - Schulick, Richard D.

AU - Edil, Barish H.

AU - Wolfgang, Christopher L.

AU - Choti, Michael A.

AU - Pawlik, Timothy M.

PY - 2012/11

Y1 - 2012/11

N2 - Background. Criteria for resectability of colon cancer liver metastases (CLM) are evolving, yet little is known about how physicians choose a therapeutic strategy for potentially resectable CLM. Methods. Physicians completed a national Web-based survey that consisted of varied CLM conjoint tasks. Respondents chose among three treatment strategies: immediate liver resection (LR), preoperative chemotherapy followed by surgery (C → LR), or palliative chemotherapy (PC). Data were analyzed by multinomial logistic regression, yielding odds ratios (OR). Results. Of 219 respondents, 79 % practiced at academic centers and 63 % were in practice ≥10 years. Median number of cases evaluated was four per month. Surgical training varied: 51 % surgical oncology, 44 % hepatopancreato- biliary/transplantation, 5 % no fellowship. Although each factor affected the choice of CLM therapy, the relative effect differed. Hilar lymph node disease predicted a strong aversion to LR with surgeons more likely to choose C → LR (OR 8.92) or PC (OR 49.9). Solitary lung metastasis also deterred choice of LR, with respondents favoring C → LR (OR 4.43) or PC (OR 6.97). After controlling for clinical factors, surgeons with more years in practice were more likely to choose PC over C → LR (OR 1.94) (P = 0.005). Surgical oncology-trained surgeons were more likely than hepatobiliary/transplant-trained surgeons to choose C → LR (OR 2.53) or PC (OR 4.15) (P<0.001). Conclusions. This is the first nationwide study to define the relative impact of key clinical factors on choice of therapy for CLM. Although clinical factors influence choice of therapy, surgical subspeciality and physician experience are also important determinants of care.

AB - Background. Criteria for resectability of colon cancer liver metastases (CLM) are evolving, yet little is known about how physicians choose a therapeutic strategy for potentially resectable CLM. Methods. Physicians completed a national Web-based survey that consisted of varied CLM conjoint tasks. Respondents chose among three treatment strategies: immediate liver resection (LR), preoperative chemotherapy followed by surgery (C → LR), or palliative chemotherapy (PC). Data were analyzed by multinomial logistic regression, yielding odds ratios (OR). Results. Of 219 respondents, 79 % practiced at academic centers and 63 % were in practice ≥10 years. Median number of cases evaluated was four per month. Surgical training varied: 51 % surgical oncology, 44 % hepatopancreato- biliary/transplantation, 5 % no fellowship. Although each factor affected the choice of CLM therapy, the relative effect differed. Hilar lymph node disease predicted a strong aversion to LR with surgeons more likely to choose C → LR (OR 8.92) or PC (OR 49.9). Solitary lung metastasis also deterred choice of LR, with respondents favoring C → LR (OR 4.43) or PC (OR 6.97). After controlling for clinical factors, surgeons with more years in practice were more likely to choose PC over C → LR (OR 1.94) (P = 0.005). Surgical oncology-trained surgeons were more likely than hepatobiliary/transplant-trained surgeons to choose C → LR (OR 2.53) or PC (OR 4.15) (P<0.001). Conclusions. This is the first nationwide study to define the relative impact of key clinical factors on choice of therapy for CLM. Although clinical factors influence choice of therapy, surgical subspeciality and physician experience are also important determinants of care.

UR - http://www.scopus.com/inward/record.url?scp=84868098773&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868098773&partnerID=8YFLogxK

U2 - 10.1245/s10434-012-2564-3

DO - 10.1245/s10434-012-2564-3

M3 - Article

VL - 19

SP - 3668

EP - 3676

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 12

ER -