Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Dipartimento di Scienze Chirurgiche, Università di Parma, Parma, Italy.
Ann Surg Oncol. 2010 Feb;17(2):432-40. doi: 10.1245/s10434-009-0830-9.
Recent trials proposed chemotherapy (CHT) as the treatment of choice for patients affected by incurable colorectal cancer (ICRC). Nevertheless, surgery is still commonly offered to these patients. On the other hand, CHT is offered to ICRC patients regardless of the pattern of spread of the disease, local or distant, despite some evidence suggesting that metastatic pattern may influence the response to treatment.
A retrospective analysis was performed of 133 patients undergoing palliative treatment for ICRC from 1994 through 2007. Palliation consisted of surgery alone until 2002 and surgery with CHT (FOLFOX-FOLFIRI) thereafter. The impact of CHT and surgery was evaluated in the whole series as well as with respect to metastatic pattern (locally aggressive primary tumor and distant metastasis only), tumor site, and grading.
Chemotherapy prolonged survival by 9 months (p = 0.001). In patients undergoing CHT, resective surgery did not prolong survival (p = 0.931), whereas in patients not undergoing CHT, it improved prognosis by 5 months (p = 0.023). Considering patients with distant metastasis only, CHT significantly prolonged survival (p < 0.001), whereas it did not improve the prognosis of patients with a locally aggressive primary tumor (p = 0.943). No difference in CHT effectiveness with respect to tumor site and grading was recorded.
CHT should be the preferred option in patients undergoing elective treatment for ICRC, whereas surgery should be considered whenever CHT is not administered. CHT significantly increases survival of patients with unresectable distant metastasis only, whereas it seems to be useless in patients with locally aggressive primary tumors.
最近的临床试验提出化疗（CHT）是不可治愈的结直肠癌（ICRC）患者的首选治疗方法。然而，手术仍然经常提供给这些患者。另一方面，无论疾病的扩散模式是局部的还是远处的，都会向 ICRC 患者提供 CHT，尽管有一些证据表明转移模式可能会影响治疗反应。
对 1994 年至 2007 年期间接受姑息治疗的 133 例 ICRC 患者进行了回顾性分析。姑息治疗包括手术直至 2002 年，以及此后的手术联合 CHT（FOLFOX-FOLFIRI）。在整个系列以及根据转移模式（局部侵袭性原发性肿瘤和远处转移仅）、肿瘤部位和分级评估 CHT 和手术的影响。
化疗将生存时间延长了 9 个月（p = 0.001）。在接受 CHT 的患者中，切除术不能延长生存时间（p = 0.931），而在未接受 CHT 的患者中，可将预后改善 5 个月（p = 0.023）。考虑到仅远处转移的患者，CHT 显著延长了生存时间（p < 0.001），而对局部侵袭性原发性肿瘤患者的预后没有改善（p = 0.943）。未观察到 CHT 有效性与肿瘤部位和分级有关。
在接受 ICRC 选择性治疗的患者中，应优先选择 CHT，而在未给予 CHT 时应考虑手术。CHT 显著增加仅无法切除的远处转移患者的生存时间，而对局部侵袭性原发性肿瘤患者似乎无用。
