Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Ann Surg Oncol. 2012 Feb;19(2):379-83. doi: 10.1245/s10434-011-2028-1. Epub 2011 Aug 23.
There is a trend toward nonsurgical management of patients with nonobstructing metastatic (stage IV) colorectal cancer (CRC), although some will eventually undergo surgery. We examined patients with metastatic CRC who were managed with an intact primary tumor.
An institutional review board (IRB)-approved database was retrospectively reviewed. All patients presenting with stage IV CRC from 2000 to 2008 were identified and analyzed.
Among the 255 patients identified, 112 were taken directly to the operating room for either primary tumor resection or colostomy/bypass. Among the remaining 143 patients, 97 were managed without developing primary tumor-related symptoms, and 14 (9.8%) developed significant primary tumor-related symptoms necessitating operative or endoscopic management. Of the patients who developed symptoms, oxaliplatin and/or irinotecan was used among 71.4% of patients, and bevacizumab in 50%. Forty-two patients in the series underwent elective primary tumor resection after receiving chemotherapy. No independent predictors for development of primary tumor-related symptoms could be identified after controlling for age, gender, tumor location, number of metastatic sites, and type of chemotherapy. Median overall survival was 34 months for those who underwent elective primary tumor resection after chemotherapy, and 16 months for those who failed chemotherapy and developed symptoms.
Among patients with metastatic CRC without an initial indication for surgery, incidence of obstruction or perforation after initiating chemotherapy was low (9.8%). No predictors of primary tumor-related complications could be identified. Survival was favorable among the highly selected cohort of patients who underwent elective primary tumor resection after chemotherapy.
尽管有些患者最终会接受手术，但对于无梗阻转移性（IV 期）结直肠癌（CRC）患者，目前存在向非手术治疗的趋势。我们研究了接受完整原发肿瘤治疗的转移性 CRC 患者。
回顾性审查了机构审查委员会（IRB）批准的数据库。确定并分析了 2000 年至 2008 年期间出现 IV 期 CRC 的所有患者。
在确定的 255 例患者中，有 112 例直接进入手术室进行原发肿瘤切除或结肠造口术/旁路手术。在其余 143 例患者中，有 97 例患者未出现与原发肿瘤相关的症状，有 14 例（9.8%）出现需要手术或内镜治疗的明显与原发肿瘤相关的症状。在出现症状的患者中，有 71.4%的患者使用了奥沙利铂和/或伊立替康，50%的患者使用了贝伐单抗。在该系列中，有 42 例患者在接受化疗后接受了择期原发肿瘤切除术。在控制年龄、性别、肿瘤位置、转移部位数量和化疗类型后，无法确定与原发肿瘤相关症状发展相关的独立预测因素。接受化疗后择期原发肿瘤切除术的患者的总生存中位数为 34 个月，而化疗失败并出现症状的患者为 16 个月。
对于初始无手术指征的转移性 CRC 患者，在开始化疗后发生梗阻或穿孔的发生率较低（9.8%）。无法确定与原发肿瘤相关并发症的预测因素。在接受化疗后择期行原发肿瘤切除术的高度选择患者队列中，生存情况良好。
