Center for Visceral and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
World J Surg. 2020 May;44(5):1604-1611. doi: 10.1007/s00268-019-05353-9.
To assess the survival outcomes among a contemporary cohort of colorectal cancer patients with isolated synchronous liver or lung metastases treated with or without surgical resection of the metastases.
Surveillance, epidemiology and end results database has been accessed and cases with isolated liver or lung metastases diagnosed 2010-2015 have been accessed. Kaplan-Meier survival estimates were used to compare overall survival among patients who had or had not undergone metastasectomy. Multivariable Cox regression analysis was then used to assess the impact of metastasectomy on colorectal cancer-specific survival.
A total of 16,372 patients with colorectal cancer with isolated liver or lung metastases (M1a disease) were included in the current analysis (including 14,832 patients with isolated liver metastases and 1540 patients with isolated lung metastases). Patients who had undergone surgical resection of liver metastases have better overall survival compared to patients who had not undergone surgical resection of liver metastases (median overall survival: 38.0 months vs. 13.0 months; P < 0.001). Likewise, patients who had undergone surgical resection of lung metastases have better overall survival compared to patients who had not undergone surgical resection of lung metastases (median overall survival: 45.0 months vs. 19.0 months; P < 0.001). In a multivariable Cox regression analysis and among patients with isolated liver metastases, surgery to the metastases was associated with a reduced hazard of death (hazard ratio (HR) 0.567; 95% CI 0.529-0.609; P < 0.001). Likewise, and among patients with isolated lung metastases, surgery to the metastases was associated with a reduced hazard of death (HR 0.482; 95% CI 0.349-0.665; P < 0.001).
In a contemporary cohort, metastasectomy seems to be associated with improvement in overall and cancer-specific survival among patients with isolated synchronous liver or lung metastases from colorectal cancer. Whether this survival difference is totally ascribed to the effect of metastasectomy or it is the fact that patients who were eligible for surgical resection have limited disease extent and better medical profile (thus, leading to better survival) is unclear from such a population-based study.
评估接受或不接受转移灶切除术的结直肠癌伴孤立性同步肝或肺转移患者的生存结局。
本研究通过访问监测、流行病学和最终结果数据库，获取了 2010 年至 2015 年期间诊断为孤立性肝或肺转移的病例。使用 Kaplan-Meier 生存估计来比较接受或未接受转移灶切除术的患者的总生存率。然后，使用多变量 Cox 回归分析评估转移灶切除术对结直肠癌特异性生存率的影响。
本研究共纳入了 16372 例结直肠癌伴孤立性肝或肺转移（M1a 期疾病）患者（包括 14832 例孤立性肝转移患者和 1540 例孤立性肺转移患者）。与未接受肝转移灶切除术的患者相比，接受肝转移灶切除术的患者的总生存率更好（中位总生存率：38.0 个月 vs. 13.0 个月；P<0.001）。同样，与未接受肺转移灶切除术的患者相比，接受肺转移灶切除术的患者的总生存率更好（中位总生存率：45.0 个月 vs. 19.0 个月；P<0.001）。在多变量 Cox 回归分析中，对于孤立性肝转移患者，转移灶切除术与死亡风险降低相关（风险比（HR）0.567；95%置信区间 0.529-0.609；P<0.001）。同样，对于孤立性肺转移患者，转移灶切除术与死亡风险降低相关（HR 0.482；95%置信区间 0.349-0.665；P<0.001）。
在当代队列中，转移灶切除术似乎与结直肠癌伴孤立性同步肝或肺转移患者的总生存率和癌症特异性生存率的提高相关。从这种基于人群的研究中尚不清楚这种生存差异是否完全归因于转移灶切除术的效果，还是因为有资格接受手术切除的患者疾病程度有限且具有更好的医疗状况（因此导致更好的生存）。
