Department of Surgery, Loma Linda University Health, 11175 Campus Street, Suite 21108, Loma Linda, CA, 92350, USA.
Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
J Gastrointest Surg. 2018 Mar;22(3):460-466. doi: 10.1007/s11605-017-3617-5. Epub 2017 Nov 9.
Resection of the primary tumor in patients with unresected metastatic colorectal cancer is controversial, and often performed only for palliation of symptoms. Our goal was to determine if resection of the primary tumor in this patient population is associated with improved survival.
This is a retrospective cohort study of the National Cancer Data Base from 2004 to 2012. The study population included all patients with synchronous metastatic colorectal adenocarcinoma who were treated with systemic chemotherapy. The study groups were patients who underwent definitive surgery for the primary tumor and those who did not. Patients were excluded if they had surgical intervention on the sites of metastasis or pathology other than adenocarcinoma. Primary outcome was overall survival.
Of the 65,543 patients with unresected stage IV colorectal adenocarcinoma undergoing chemotherapy, 55% underwent surgical resection of the primary site. Patients who underwent surgical resection of the primary tumor had improved median survival compared to patients treated with chemotherapy alone (22 vs 13 months, p < .0001). The surgical survival benefit was present for patients who were treated with either multi-agent or single-agent chemotherapy (23 vs 14 months, p < 0.001; 19 vs 9 months, p < 0.001). Surgical resection of the primary tumor was also associated with improved survival when using multivariate analysis with propensity score matching (OR = 0.863; 95% CI [0.805-.924]; HR = 0.914; 95% CI [0.888-0.942]).
Our results show that in patients with synchronous unresected stage IV colorectal adenocarcinoma undergoing single- or multi-agent chemotherapy, after adjusting for confounding variables, definitive resection of the primary site was associated with improved overall survival. Large randomized controlled trials are needed to determine if there is a causal relationship between surgery and increased overall survival in this patient population.
对于未切除的转移性结直肠癌患者，切除原发肿瘤存在争议，通常仅为缓解症状而行姑息性切除。我们的目标是确定在这一患者人群中，切除原发肿瘤是否与生存改善相关。
这是一项回顾性队列研究，纳入了 2004 年至 2012 年国家癌症数据库中的患者。研究人群包括所有接受全身化疗的同步转移性结直肠腺癌患者。研究组为接受原发肿瘤确定性手术的患者和未接受手术的患者。排除接受转移部位手术干预或病理检查非腺癌的患者。主要结局为总生存。
在 65543 例接受化疗的未切除的 IV 期结直肠腺癌患者中，55%的患者接受了原发部位的手术切除。与单纯化疗相比，接受原发肿瘤手术切除的患者中位生存时间更长（22 个月 vs 13 个月，P < 0.0001）。多药化疗或单药化疗的患者均有手术生存获益（23 个月 vs 14 个月，P < 0.001；19 个月 vs 9 个月，P < 0.001）。使用倾向性评分匹配的多变量分析时，手术切除原发肿瘤也与生存改善相关（OR=0.863；95%CI[0.805-0.924]；HR=0.914；95%CI[0.888-0.942]）。
我们的结果表明，在接受单药或多药化疗的同步未切除 IV 期结直肠腺癌患者中，在调整混杂因素后，明确切除原发肿瘤与总生存改善相关。需要开展大型随机对照试验以确定在该患者人群中，手术与总生存改善之间是否存在因果关系。
