Li Xiao-Fen, Tan Yi-Nuo, Zhong Chen-Han, Zhu Li-Zhen, Fang Xue-Feng, Li Jun, Ding Ke-Feng, Yuan Ying
Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Oncotarget. 2017 Jun 30;8(45):79618-79628. doi: 10.18632/oncotarget.18896. eCollection 2017 Oct 3.
The role of surgery in metastatic colorectal cancer (mCRC) remains controversial. This study was performed to assess the impact of surgery on survival in metastatic colorectal cancer.
Information of mCRC patients diagnosed between January 1, 2004, and December 31, 2013, was retrieved from the Surveillance, Epidemiology, and End Results Program database. Patients were classified in three groups: patients undergoing resection of both primary and distant metastatic tumors (group 'PMTR'), patients receiving primary tumor resection alone (group 'PTR') and patients not undergoing any surgery (group 'No resection'). Kaplan-Meier method and multivariate Cox proportional hazard regression analysis were applied to estimate disease specific survival time (DSS) and determine prognostic factors.
A total of 38,591 mCRC patients were eligible. Overall, median DSS of group 'PMTR' was significantly longer compared with group 'PTR' and group 'No resection' (28.0 vs 21.0 vs 11.0 months, < 0.001). Stratified analysis observed that primary tumor in left-sided colorectal cancer (LCRC) was a favorable prognostic factor compared with right-sided colorectal cancer (RCRC) (median DSS of LCRC: PMTR, 34 months, PTR, 25 months, No resection, 13 months; median DSS of RCRC: PMTR, 20 months, PTR, 16 months, No resection, 8 months; < 0.001). Multivariate analysis demonstrated that surgery was an independent prognostic factor for better survival (PMTR, HR = 0.403, 95% CI 0.384-0.423, < 0.001; PTR, HR = 0.515, 95% CI 0.496-0.534, < 0.001). Furthermore, in patients undergoing surgery, patients with younger age, female, married status, LCRC and lower CEA level were prone to receiving PMTR.
This analysis demonstrated that surgery was an independent prognostic factor for improved survival in mCRC. Patients with LCRC had better survival than patients with RCRC after surgery.
手术在转移性结直肠癌（mCRC）中的作用仍存在争议。本研究旨在评估手术对转移性结直肠癌患者生存的影响。
从监测、流行病学和最终结果计划数据库中检索2004年1月1日至2013年12月31日期间诊断为mCRC患者的信息。患者分为三组：接受原发肿瘤和远处转移瘤切除的患者（“PMTR”组）、仅接受原发肿瘤切除的患者（“PTR”组）和未接受任何手术的患者（“未切除”组）。采用Kaplan-Meier法和多变量Cox比例风险回归分析来估计疾病特异性生存时间（DSS）并确定预后因素。
共有38591例mCRC患者符合条件。总体而言，“PMTR”组的中位DSS显著长于“PTR”组和“未切除”组（28.0个月对21.0个月对11.0个月，P<0.001）。分层分析观察到，与右侧结直肠癌（RCRC）相比，左侧结直肠癌（LCRC）中的原发肿瘤是一个有利的预后因素（LCRC的中位DSS：PMTR组为34个月，PTR组为25个月，未切除组为13个月；RCRC的中位DSS：PMTR组为20个月，PTR组为16个月，未切除组为8个月；P<0.001）。多变量分析表明，手术是生存改善的独立预后因素（PMTR组，HR = 0.403，95%CI 0.384 - 0.423，P<0.001；PTR组，HR = 0.515，95%CI 0.496 - 0.534，P<0.001）。此外，在接受手术的患者中，年龄较小、女性、已婚状态、LCRC以及CEA水平较低的患者更容易接受PMTR。
该分析表明，手术是mCRC患者生存改善的独立预后因素。手术后，LCRC患者的生存情况优于RCRC患者。
