The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China; Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China; School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China.
Int J Surg. 2020 Aug;80:135-152. doi: 10.1016/j.ijsu.2020.06.024. Epub 2020 Jul 4.
There is a great matter of controversies whether some of these synchronous metastatic colorectal cancer patients can benefit from palliative primary tumor resection (pPTR) and there is still no reported randomized control trial to address this issue.
Patients with microscopically proven metastatic colorectal cancer were identified within the SEER database (2010-2016). Patients were propensity matched 1:1 into pPTR and non-surgery groups and among the matched cohort, the univariable and multivariable Cox proportional hazards regression models were performed to identify predictors of survival. Median survival was calculated by using the Kaplan-Meier method.
Of 21,405 colorectal cancer patients diagnosed with synchronous liver and/or lung metastases, 7386 were identified in the matched cohort. The median overall survival was 12.0 months, 22.0 months in the non-surgery, surgery groups, respectively (p < 0.001) and the corresponding median cancer-specific survival was 13.0 months, 22.0 months, respectively (p < 0.001). Multivariable Cox regression analysis demonstrated that surgery was independently associated with improved overall survival (hazard ratio, 0.531) as well as cancer-specific survival (hazard ratio, 0.516). In stratified analyses by primary site and patterns of distant metastases, those patients with pPTR had better prognosis. In addition, stratified analysis revealed that trimodality therapy was linked with the greatest therapeutic effect followed by addition of chemotherapy to pPTR.
pPTR may offer some therapeutic benefits among carefully selected patients, and surgery-based multimodality therapy was associated with better survival.
一些同时患有转移性结直肠癌的患者是否能从姑息性原发肿瘤切除（pPTR）中获益存在很大争议，目前尚无报道的随机对照试验来解决这个问题。
在 SEER 数据库（2010-2016 年）中确定了经显微镜证实的转移性结直肠癌患者。将患者按 1:1 比例进行倾向评分匹配，分为 pPTR 组和非手术组，并在匹配队列中，采用单变量和多变量 Cox 比例风险回归模型来确定生存的预测因素。采用 Kaplan-Meier 方法计算中位生存时间。
在 21405 例诊断为同时患有肝和/或肺转移的结直肠癌患者中，有 7386 例患者纳入匹配队列。总生存的中位数为 12.0 个月，非手术组和手术组分别为 22.0 个月（p<0.001），相应的中位癌症特异性生存分别为 13.0 个月和 22.0 个月（p<0.001）。多变量 Cox 回归分析表明，手术与总生存（风险比，0.531）和癌症特异性生存（风险比，0.516）的改善独立相关。按原发部位和远处转移模式进行分层分析，接受 pPTR 的患者预后较好。此外，分层分析显示，三联疗法的治疗效果最大，其次是在 pPTR 基础上添加化疗。
在仔细选择的患者中，pPTR 可能提供一些治疗益处，基于手术的多模式治疗与更好的生存相关。
