Zhang Chi-Hao, Pan Yuan-Bo, Zhang Qing-Wei, Shi Ou-Min, Zheng Lei, Gui Liang, Luo Meng
Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China.
Department of Neurosurgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China.
J Cancer Res Clin Oncol. 2017 Sep;143(9):1891-1903. doi: 10.1007/s00432-017-2442-2. Epub 2017 May 22.
This study was aimed to determine the effect of the local tumor therapy on patients' prognosis in the management of metastatic rectal cancer.
Patients diagnosed with metastatic rectal cancer from 2004 to 2013 were selected from the SEER (Surveillance, Epidemiology, and End Results) database. Overall survival and cancer-specific survival were compared between the local treatment group and the nonlocal treatment group using Kaplan-Meier methods. Uni- and multivariate analyses were further performed to confirm or deny the results. The statistical approach of propensity score matching was conducted to avoid potential confounding factors.
Of 6867 patients included in this analysis, 3971 (57.8%) received local therapy to the primary tumor and 2896 (42.2%) did not receive. Both univariable and multivariable analysis showed local therapy continued to be associated with an improvement in OS (HR 0.532; 95% CI 0.503-0.563, p < 0.001 and HR 0.532; 95% CI 0.498-0.568, p < 0.001, respectively) and CSS (HR 0.527; 95% CI 0.497-0.559, p < 0.001 and HR 0.521; 95% CI 0.487-0.557, p < 0.001, respectively) in the unmatched cohorts. Further analysis showed patients underwent local tumor destruction or surgical resection had a better overall survival compared with those who did not undergo (p < 0.001). In the matched population, patients receiving local therapy had a better OS (HR 0.427; 95% CI 0.428-0.519, p < 0.001) and CSS (HR 0.462; 95% CI 0.418-0.511, p < 0.001) compared with those who did not receive.
Local therapy to the primary tumor may be associated with a better survival in patients with metastatic rectal cancer.
本研究旨在确定局部肿瘤治疗对转移性直肠癌患者预后的影响。
从SEER（监测、流行病学和最终结果）数据库中选取2004年至2013年诊断为转移性直肠癌的患者。使用Kaplan-Meier方法比较局部治疗组和非局部治疗组的总生存期和癌症特异性生存期。进一步进行单因素和多因素分析以证实或否定结果。采用倾向评分匹配的统计方法以避免潜在的混杂因素。
在本分析纳入的6867例患者中，3971例（57.8%）接受了原发肿瘤的局部治疗，2896例（42.2%）未接受。单因素和多因素分析均显示，在未匹配的队列中，局部治疗与总生存期（HR 0.532；95%CI 0.503 - 0.563，p < 0.001和HR 0.532；95%CI 0.498 - 0.568，p < 0.001）及癌症特异性生存期（HR 0.527；95%CI 0.497 - 0.559，p < 0.001和HR 0.521；95%CI 0.487 - 0.557，p < 0.001）的改善相关。进一步分析显示，与未接受局部肿瘤破坏或手术切除的患者相比，接受局部肿瘤破坏或手术切除的患者总生存期更好（p < 0.001）。在匹配人群中，接受局部治疗的患者与未接受局部治疗的患者相比，总生存期（HR 0.427；95%CI 0.428 - 0.519，p < 0.001）及癌症特异性生存期（HR 0.462；95%CI 0.418 - 0.511，p < 0.001）更好。
对原发肿瘤进行局部治疗可能与转移性直肠癌患者更好的生存期相关。
