Ergun Yakup, Bal Oznur, Dogan Mutlu, Ucar Gokhan, Dirikoc Merve, Acikgoz Yusuf, Bacaksiz Ferhat, Uncu Dogan
Department of Medical Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Department of Gastroenterology, Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
J Res Med Sci. 2020 Feb 20;25:14. doi: 10.4103/jrms.JRMS_1056_18. eCollection 2020.
Primary tumor resection (PTR) in metastatic colorectal cancer (mCRC) has not been suggested by guidelines, since new systemic chemotherapy options have improved overall survival. However, the effect of PTR is still controversial in mCRC. In this study, we aimed to evaluate the effect of PTR on survival in unresectable mCRC.
Two hundred and fifty-two patients with unresectable mCRC were screened retrospectively between January 2007 and December 2017 and a total of 147 patients who met inclusion criteria were included. The patients with emergency or elective PTR and the patients without surgery were compared for baseline features and overall survival.
The median follow-up time was 15.6 months (range; 1.2-78.9) in whole patients. There were 91 patients in nonsurgical (NS) group and 56 patients in PTR group. The median overall survival was significantly longer in PTR group compared NS group (21.8 vs. 17.0 months, = 0.01), but it was not associated to better overall survival in multivariate Cox analysis (hazard ratio: 0.65, 95% confidence interval: 0.41-1.02, = 0.06). There was no significant difference in overall survival between emergency and elective surgery subgroups (22.9 vs. 16.1 months, respectively, = 0.9).
PTR did not offer an overall survival benefit in this study. Although it is debated, we think that it is better to start treatment with chemotherapy and biological agent combinations in patients with asymptomatic mCRC. Thus, the patients can be protected from the morbidity and mortality of the surgery.
由于新的全身化疗方案提高了总体生存率，转移性结直肠癌（mCRC）的原发性肿瘤切除（PTR）未被指南推荐。然而，PTR在mCRC中的效果仍存在争议。在本研究中，我们旨在评估PTR对不可切除mCRC患者生存的影响。
回顾性筛选2007年1月至2017年12月期间252例不可切除mCRC患者，共纳入147例符合纳入标准的患者。比较接受急诊或择期PTR的患者与未接受手术的患者的基线特征和总体生存率。
所有患者的中位随访时间为15.6个月（范围：1.2 - 78.9个月）。非手术（NS）组91例患者，PTR组56例患者。与NS组相比，PTR组的中位总生存期显著更长（21.8个月对17.0个月，P = 0.01），但在多因素Cox分析中与更好的总生存期无关（风险比：0.65，95%置信区间：0.41 - 1.02，P = 0.06）。急诊手术亚组和择期手术亚组的总生存期无显著差异（分别为22.9个月和16.1个月，P = 0.9）。
本研究中PTR未带来总生存获益。尽管存在争议，但我们认为对于无症状mCRC患者，最好开始使用化疗和生物制剂联合治疗。这样可以使患者免受手术的发病率和死亡率影响。
