Wancata Lauren M, Banerjee Mousumi, Muenz Daniel G, Haymart Megan R, Wong Sandra L
Department of Surgery, University of Michigan, North Campus Research Complex, Ann Arbor, Michigan.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
J Surg Res. 2016 Mar;201(1):196-201. doi: 10.1016/j.jss.2015.10.021. Epub 2015 Oct 23.
Recent data show patients with advanced colorectal cancer (CRC) are surviving longer. What is unknown is how specific treatment modalities affect long-term survival. Conditional survival, or survival prognosis based on time already survived, is becoming an acceptable means of estimating prognosis for long-term survivors. We evaluated the impact of cancer-directed surgery on long-term survival in patients with advanced CRC.
We used Surveillance, Epidemiology, and End Results data to identify 64,956 patients with advanced (Stage IV) CRC diagnosed from 2000-2009. Conditional survival estimates by stage, age, and cancer-directed surgery were obtained based on Cox proportional hazards regression model of disease-specific survival.
A total of 64,956 (20.1%) patients had advanced disease at the time of diagnosis. The proportion of those patients who underwent cancer-directed surgery was 65.1% (n = 42,176). Cancer-directed surgery for patients with advanced stage disease was associated with a significant improvement in traditional survival estimates compared to patients who did not undergo surgery (hazard ratio = 2.22 [95% confidence interval, 2.17-2.27]). Conditional survival estimates show improvement in conditional 5-y disease-specific survival across all age groups, demonstrating sustained survival benefits for selected patients with advanced CRC.
Five-year disease-specific conditional survival improves dramatically over time for selected patients with advanced CRC who undergo cancer-directed surgery. This information is important in determining long-term prognosis and will help inform treatment planning for advanced CRC.
近期数据显示，晚期结直肠癌（CRC）患者的生存期延长。目前尚不清楚的是，具体的治疗方式如何影响长期生存。条件生存，即基于已存活时间的生存预后，正成为评估长期幸存者预后的一种可接受的方法。我们评估了针对癌症的手术对晚期CRC患者长期生存的影响。
我们使用监测、流行病学和最终结果数据，确定了2000年至2009年期间诊断为晚期（IV期）CRC的64956例患者。基于疾病特异性生存的Cox比例风险回归模型，获得了按分期、年龄和针对癌症的手术进行的条件生存估计。
共有64956例（20.1%）患者在诊断时患有晚期疾病。接受针对癌症手术的患者比例为65.1%（n = 42176）。与未接受手术的患者相比，针对晚期疾病患者进行的针对癌症的手术与传统生存估计的显著改善相关（风险比 = 2.22 [95%置信区间，2.17 - 2.27]）。条件生存估计显示，所有年龄组的条件5年疾病特异性生存均有改善，表明选定的晚期CRC患者具有持续的生存益处。
对于接受针对癌症手术的选定晚期CRC患者，5年疾病特异性条件生存随时间显著改善。该信息对于确定长期预后很重要，并将有助于为晚期CRC的治疗规划提供参考。
