Zong Zhen, Zhou Tai-Cheng, Tang Fu-Xin, Tian Hua-Kai, Wang Anan, Yi Cheng-Hao
From the *Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, P. R. China; and.
†Department of Gastrointestinal Surgery and Hernia Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, P. R. China.
Am Surg. 2020 Mar 1;86(3):220-227.
We aimed to explore the potential prognostic impact of the metastatic site on the management approach and prognosis of stage IV colorectal cancer patients with synchronous metastases. Synchronous metastatic colorectal cancer patients reported to the Surveillance, Epidemiology, and End Results Program database between 2010 and 2013 were included in this study. Overall survival (OS) was compared between patients with different treatment options using risk-adjusted Cox proportional hazard regression models. Overall, 17,776 patients with stage IV colorectal cancer were identified. Of these patients, 2,052 (11.5%) underwent surgical resection for tumors at both the primary and metastatic sites. Patients who underwent surgical resection of both primary and metastatic sites with liver, lung, and simultaneous liver and lung metastases had a longer median OS ( < 0.001) than patients who underwent nonsurgical treatments. Cox regression analysis revealed that surgical resection of both primary and metastatic sites was associated with a significantly enhanced OS ( < 0.001). Colorectal cancer patients with hepatic or pulmonary metastases, who underwent metastasectomy, even in selected patients with both hepatic and pulmonary metastases after multidisciplinary evaluation, could have a better survival benefit than patients who underwent nonsurgical treatments.
我们旨在探讨转移部位对伴有同步转移的IV期结直肠癌患者治疗方案及预后的潜在预后影响。本研究纳入了2010年至2013年期间向监测、流行病学和最终结果计划数据库报告的同步转移性结直肠癌患者。使用风险调整的Cox比例风险回归模型比较不同治疗方案患者的总生存期（OS）。总体而言，共识别出17776例IV期结直肠癌患者。其中，2052例（11.5%）患者接受了原发灶和转移灶肿瘤的手术切除。与接受非手术治疗的患者相比，接受原发灶和转移灶（包括肝转移、肺转移以及同时存在肝肺转移）手术切除的患者中位OS更长（<0.001）。Cox回归分析显示，原发灶和转移灶的手术切除与显著延长的OS相关（<0.001）。即使是经过多学科评估后选择的同时存在肝肺转移的结直肠癌患者，接受肝转移或肺转移切除术的患者比接受非手术治疗的患者可能具有更好的生存获益。
