原发性肿瘤切除及特定转移部位切除与Ⅳ期结直肠癌患者生存率提高相关吗？来自监测、流行病学和最终结果（SEER）数据库分析的结果

Is Primary Tumor Excision and Specific Metastases Sites Resection Associated With Improved Survival in Stage Ⅳ Colorectal Cancer? Results From SEER Database Analysis.

作者信息

Yi Chenghao, Li Jinpeng, Tang Fuxin, Ning Zhikun, Tian Huakai, Xiao Longlin, Wang Anan, Zong Zhen

机构信息

47861 Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

47861 Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

出版信息

Am Surg. 2020 May;86(5):499-507. doi: 10.1177/0003134820919729.

DOI:10.1177/0003134820919729

PMID:32684032

Abstract

OBJECTIVE

We aimed to explore the prognostic value of primary tumor and specific metastases excision on survival among patients with stage IV colorectal cancer (CRC) in the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

Patients with stage IV CRC were selected using SEER database between 2010 and 2013. Survival rate was calculated according to the Kaplan-Meier method, and differences between curves were tested by the log-rank test. Cox proportional hazards model was used in the multivariable analysis.

RESULTS

Included in this study were 27 878 patients with distant metastatic CRC. Among the single organ site of metastatic CRC, patients with solitary metastasis of lung showed the highest median overall survival (OS). Both primary and metastatic sites surgical resection for patients with liver, lung, and simultaneous liver and lung metastases had better median OS. Age younger than 65 years, Asian and Pacific Islander, distal colon and rectum, and palliative primary tumor and metastatic lesions resection were associated with better OS after multivariate analysis. Palliative primary tumor and metastatic lesions resection had a significant survival benefit compared with nonsurgical group in selected patients.

CONCLUSION

These findings support the use of preemptive surgery in the management of highly selected metastatic CRC patients.

摘要

目的

我们旨在利用监测、流行病学和最终结果（SEER）数据库，探讨原发性肿瘤和特定转移灶切除对IV期结直肠癌（CRC）患者生存的预后价值。

方法

使用SEER数据库选取2010年至2013年间的IV期CRC患者。根据Kaplan-Meier方法计算生存率，并通过对数秩检验检验曲线之间的差异。多变量分析采用Cox比例风险模型。

结果

本研究纳入了27878例远处转移性CRC患者。在转移性CRC的单一器官部位中，肺孤立转移患者的中位总生存期（OS）最高。肝、肺以及肝肺同时转移患者的原发灶和转移灶手术切除均具有更好的中位OS。多变量分析显示，年龄小于65岁、亚太岛民、远端结肠和直肠以及姑息性原发性肿瘤和转移灶切除与更好的OS相关。在选定患者中，姑息性原发性肿瘤和转移灶切除与非手术组相比具有显著的生存获益。