Birkett Richard T, O'Donnell Maj Mary T, Epstein Andrew J, Saur Nicole M, Bleier Joshua I S, Paulson Emily Carter
University of Pennsylvania, Perelman School of Medicine, Department of Surgery, Division of Colon and Rectal Surgery, Philadelphia, PA, USA.
University of Pennsylvania, Perelman School of Medicine, Department of Surgery, Division of Colon and Rectal Surgery, Philadelphia, PA, USA.
Surg Oncol. 2019 Mar;28:110-115. doi: 10.1016/j.suronc.2018.11.010. Epub 2018 Nov 13.
Evidence suggests that elective primary colon resection (ePCR) in patients with asymptomatic colon tumors and unresectable metastases is not required and may expose patients to unnecessary operative risk.
Stage IV colon cancer patients with liver metastases from 2000 to 2011 were identified with SEER-Medicare data. Liver-based therapy or urgent/emergent colectomies were excluded. Chemotherapy alone was compared to ePCR ± chemotherapy. Univariate and multivariate analyses were used to identify predictors of ePCR. Multivariate Cox regression compared survival.
5139 patients were identified. The ePCR rate decreased over time; 84% underwent ePCR in 2000, compared to 52% in 2011 (p < 0.001). In multivariate analysis, older patients were more likely to undergo ePCR, as were patients from rural areas (OR 1.65, p < 0.001). The odds of PCR in high poverty areas (>10%) were almost 25% higher than those in low poverty areas (OR 1.23, p = 0.03). African-Americana were less likely to undergo PCR than Caucasians (OR 0.76, p = 0.01). In multivariate survival analysis, PCR was associated with a significant survival benefit (HR 0.59, p < 0.001).
Although ePCR is not recommended with unresectable metastases and the rate has decreased significantly, over 50% of patients with untreated hepatic metastases underwent ePCR in 2011. Disparities exist in use of ePCR that are likely multifactorial and deserve further study.
有证据表明，对于无症状结肠肿瘤且有不可切除转移灶的患者，无需进行择期原发性结肠切除术（ePCR），这可能会使患者面临不必要的手术风险。
利用监测、流行病学和最终结果（SEER）医保数据，确定2000年至2011年期间出现肝转移的IV期结肠癌患者。排除基于肝脏的治疗或急诊/紧急结肠切除术。将单纯化疗与ePCR±化疗进行比较。采用单因素和多因素分析来确定ePCR的预测因素。多因素Cox回归分析比较生存率。
共确定了5139例患者。ePCR率随时间下降；2000年84%的患者接受了ePCR，而2011年这一比例为52%（p<0.001）。在多因素分析中，老年患者以及农村地区的患者更有可能接受ePCR（比值比[OR]为1.65，p<0.001）。高贫困地区（>10%）进行PCR的几率比低贫困地区高出近25%（OR为1.23，p=0.03）。非裔美国人比白种人接受PCR的可能性更小（OR为0.76，p=0.01）。在多因素生存分析中，PCR与显著的生存获益相关（风险比[HR]为0.59，p<0.001）。
尽管对于有不可切除转移灶的患者不建议进行ePCR，且该比例已显著下降，但2011年仍有超过50%未经治疗的肝转移患者接受了ePCR。ePCR的使用存在差异，可能是多因素导致的，值得进一步研究。
