Mukai Toshiki, Uehara Keisuke, Aiba Toshisada, Nakamura Hayato, Ebata Tomoki, Nagino Masato
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Anus Rectum Colon. 2018 Mar 9;2(1):16-24. doi: 10.23922/jarc.2017-021. eCollection 2018.
The purpose of this study is to summarize our short- and long-term treatment results for stage IV colorectal cancer (CRC) and to clarify the factors predicting the favorable long-term survival.
Between January 2008 and December 2015, 149 consecutive patients with stage IV CRC underwent initial treatment at Nagoya University Hospital. Their clinical and pathological characteristics, the treatment methods used, and the outcomes were retrospectively analyzed.
The median observation period was 23 months. All of the primary and metastatic lesions were technically resectable in 74 patients; however, the remaining 75 were judged as initially unresectable. R0/1 resection during the treatment course was achieved in 74 patients (50%). For the cohort as a whole, the 5-year overall survival (OS) rate was 35%. The 5-year OS rate in the R0/1 resection group was 57%, which was significantly better than that of the non-R0/1 resection group (6%, < 0.001). In the R0/1 resection group, perioperative chemotherapy significantly improved the outcome (5-year OS; 62% vs. 0%, = 0.03). In the non-R0/1 resection group, primary tumor resection was associated with a significantly higher favorable prognosis (3-year OS; 20.4% vs. 0%, = 0.026). Moreover, the additional use of molecular targeted drugs significantly improved the survival. In multivariate analysis, the differentiated histologic type, R0/1 resection, and parallel use of molecular targeted drugs remained independent factors of a favorable outcome.
The present study suggested that aggressive curative resection with perioperative chemotherapy might improve survival and that primary tumor resection might improve the outcome in the non-R0/1 group.
本研究旨在总结我们对IV期结直肠癌（CRC）的短期和长期治疗结果，并阐明预测长期良好生存的因素。
2008年1月至2015年12月期间，149例连续的IV期CRC患者在名古屋大学医院接受了初始治疗。对他们的临床和病理特征、所采用的治疗方法及结果进行了回顾性分析。
中位观察期为23个月。74例患者的所有原发和转移病灶在技术上均可切除；然而，其余75例被判定为初始不可切除。74例患者（50%）在治疗过程中实现了R（0/1）切除。对于整个队列，5年总生存率（OS）为35%。R（0/1）切除组的5年OS率为57%，显著优于非R（0/1）切除组（6%，P<0.001）。在R（0/1）切除组中，围手术期化疗显著改善了结局（5年OS；62%对0%，P=0.03）。在非R（0/1）切除组中，原发肿瘤切除与显著更高的良好预后相关（3年OS；20.4%对0%，P=0.026）。此外，分子靶向药物的额外使用显著改善了生存。在多变量分析中，分化组织学类型、R（0/1）切除以及分子靶向药物的联合使用仍然是良好结局的独立因素。
本研究表明，积极的根治性切除联合围手术期化疗可能改善生存，并且原发肿瘤切除可能改善非R（0/1）组的结局。
