Departments of Radiation Oncology.
Medical Oncology.
Am J Clin Oncol. 2020 Dec 1;43(12):850-856. doi: 10.1097/COC.0000000000000764.
When, whether, and in whom primary tumor resection (PTR) for patients with metastatic colorectal cancer (CRC) is indicated remains unknown. With advances in multiagent systemic chemotherapy, PTR may be undertaken less frequently. The aim of this study was to obtain estimates of changes in the utilization of PTR and chemotherapy for metastatic CRC.
Patients diagnosed with metastatic CRC between 2000 and 2016 were identified from Surveillance Epidemiology, and End Results (SEER) registry. Multivariable logistic regression defined odds of undergoing PTR. The analysis was also stratified by primary site (colon vs. rectum), age (younger than 50 vs. 50 y and older), and whether patients also underwent resection of metastatic sites (yes vs. no). The secondary endpoint of interest was the receipt of any chemotherapy, also assessed by multivariable logistic regression.
Among 99,835 patients with metastatic CRC, 55,527 (55.7%) underwent PTR. The odds of undergoing PTR decreased with a later year of diagnosis, with patients diagnosed in 2016 being 61.1% less likely to undergo surgery than those diagnosed in 2000 (adjusted odds ratio=0.39, 95% confidence interval: 0.36-0.42, P<0.0001; absolute percentage: 62.3% to 43.8%). Similar trends by year for PTR were observed among each of the subgroups, although patients with colon primary, young adults (age younger than 50 y), and patients also undergoing metastasectomy were more likely to undergo PTR (P<0.001 for all). In contrast, the odds of receiving chemotherapy increased dramatically with a later year of diagnosis (adjusted odds ratio=2.21, 95% confidence interval: 2.04-2.40, P<0.0001).
From 2000 to 2016, there was a sharp decline in the rate of PTR for patients with metastatic CRC, while the use of chemotherapy increased over the same period. Prospective studies are needed to define the optimal local treatment for patients with metastatic CRC.
对于转移性结直肠癌（CRC）患者，何时、是否以及对哪些患者进行原发肿瘤切除术（PTR）尚不清楚。随着多药物全身化疗的进步，PTR 的实施可能会越来越少。本研究旨在评估转移性 CRC 患者 PTR 和化疗的应用变化。
从监测、流行病学和最终结果（SEER）登记处确定 2000 年至 2016 年间诊断为转移性 CRC 的患者。多变量逻辑回归定义了接受 PTR 的几率。该分析还按原发部位（结肠 vs. 直肠）、年龄（<50 岁与 50 岁及以上）以及患者是否还接受转移部位切除术（是 vs. 否）进行分层。感兴趣的次要终点是接受任何化疗，也通过多变量逻辑回归进行评估。
在 99835 例转移性 CRC 患者中，有 55527 例（55.7%）接受了 PTR。接受 PTR 的几率随着诊断年份的推移而降低，2016 年诊断的患者接受手术的可能性比 2000 年诊断的患者低 61.1%（调整后的优势比=0.39，95%置信区间：0.36-0.42，P<0.0001；绝对百分比：62.3%降至 43.8%）。虽然结肠原发、年轻人（<50 岁）和也接受转移切除术的患者更有可能接受 PTR（所有 P<0.001），但 PTR 随年份的相似趋势在每个亚组中均可见。相反，随着诊断年份的推移，接受化疗的几率显著增加（调整后的优势比=2.21，95%置信区间：2.04-2.40，P<0.0001）。
从 2000 年到 2016 年，转移性 CRC 患者 PTR 的比率急剧下降，而同期化疗的应用增加。需要前瞻性研究来确定转移性 CRC 患者的最佳局部治疗方法。
