Colorectal Unit, Department of Surgery and Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås, Sweden.
Colorectal Unit, Department of Surgery and Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås, Sweden.
Surg Oncol. 2019 Jun;29:102-106. doi: 10.1016/j.suronc.2019.04.005. Epub 2019 Apr 11.
The aim was to identify patient-, tumor- and treatment-related prognostic factors for five-year survival in rectal cancer patients with synchronous stage IV disease.
This nationwide case-control study was based on the Swedish Colorectal Cancer Registry with supplementary information from medical records and the Swedish Inpatient Registry during the period 2000-2008. All resected rectal cancer patients with synchronous metastases that survived more than five years were included as cases. The control group consisted of corresponding patients who lived less than five years, matched in a 1:2 based on gender, age, resection of the rectal tumor, and the study period.
A total of 405 patients were identified; 99 long-term survivors (LTS) and 182 short-term survivors (STS). Patient-related factors of symptoms and comorbidity did not differ between LTS and STS. Among the treatment-related factors, multiple site metastases (p = 0.007), bilobar liver metastasis (p = 0.002), and increasing number of liver metastasis (p < 0.001) were associated with STS. Prognostic treatment-related factors were preoperative radiotherapy (p = 0.001), metastasectomy (p < 0.001), and radical resection of the primary tumor (p = 0.014). In the multivariable analysis, the single most important factor for becoming a LTS was a metastasectomy (hazard ratio: 8.474, 95% confidence interval: 4.098-17.543).
The most important prognostic factor for long-term survival in patients with stage IV rectal cancer was metastasectomy, especially liver surgery. With thorough selection of patients for metastasectomy more patients with metastasized rectal cancer may survive beyond five years.
本研究旨在确定伴有同步 IV 期疾病的直肠癌患者五年生存率的患者、肿瘤和治疗相关的预后因素。
这是一项全国范围内的病例对照研究，基于瑞典结直肠癌登记处的数据，同时结合了 2000-2008 年期间的病历和瑞典住院患者登记处的补充信息。所有接受同步转移灶切除术且生存时间超过五年的直肠癌患者均被纳入病例组。对照组由生存时间少于五年的相应患者组成，按照性别、年龄、直肠肿瘤切除术和研究期间进行 1:2 匹配。
共纳入 405 例患者，其中 99 例为长期幸存者（LTS），182 例为短期幸存者（STS）。LTS 和 STS 之间在症状和合并症等患者相关因素方面没有差异。在治疗相关因素中，多发转移灶（p=0.007）、双侧肝转移（p=0.002）和肝转移灶数量增加（p<0.001）与 STS 相关。术前放疗（p=0.001）、转移灶切除术（p<0.001）和直肠肿瘤根治性切除术（p=0.014）是与预后相关的治疗因素。在多变量分析中，成为 LTS 的最重要单一因素是转移灶切除术（风险比：8.474，95%置信区间：4.098-17.543）。
在 IV 期直肠癌患者中，长期生存的最重要预后因素是转移灶切除术，尤其是肝转移灶切除术。通过对转移灶切除术患者进行严格选择，可能会有更多的转移性直肠癌患者生存时间超过五年。
