Tharin Zoé, Blanc Julie, Alaoui Ikram Charifi, Bertaut Aurélie, Ghiringhelli François
Department of Medical Oncology, Centre Georges-François Leclerc, Dijon 21000, France.
Department of Bioastatistics, Centre Georges-François Leclerc, Dijon 21000, France.
World J Gastrointest Oncol. 2020 Nov 15;12(11):1296-1310. doi: 10.4251/wjgo.v12.i11.1296.
Patients with right sided colorectal cancer are known to have a poorer prognosis than patients with left sided colorectal cancer, whatever the cancer stage. To this day, primary tumor resection (PTR) is still controversial in a metastatic, non resectable setting.
To explore the survival impact of PTR in patients with metastatic colorectal cancer (mCRC) depending on PTL.
We retrospectively collected data from all consecutive patients treated for mCRC at the Centre Georges Francois Leclerc Hospital. Univariate and multivariate Cox proportional hazard regression models were used to assess the influence of PTR on survival. We then evaluated the association between PTL and overall survival among patients who previously underwent or did not undergo PTR. A propensity score was performed to match cohorts.
Four hundred and sixty-six patients were included. A total of 153 (32.8%) patients had unresected synchronous mCRC and 313 (67.2%) patients had resected synchronous mCRC. The number of patients with right colic cancer, left colic cancer and rectal cancer was respectively 174 (37.3%), 203 (43.6%) and 89 (19.1%). In the multivariate analysis only PTL, PTR, resection of hepatic and or pulmonary metastases and the use of oxaliplatin, EGFR inhibitors or bevacizumab throughout treatment were associated to higher overall survival rates. Survival evaluation depending on PTR and PTL found that PTR improved the prognosis of both left and right sided mCRC. Results were confirmed by using a weighted propensity score.
In mCRC, PTR seems to confer a higher survival rate to patients whatever the PTL.
众所周知，无论癌症处于何种阶段，右侧结直肠癌患者的预后都比左侧结直肠癌患者差。时至今日，在转移性、不可切除的情况下，原发性肿瘤切除术（PTR）仍存在争议。
探讨根据原发性肿瘤位置（PTL），PTR对转移性结直肠癌（mCRC）患者生存的影响。
我们回顾性收集了乔治·弗朗索瓦·勒克莱尔中心医院所有连续治疗的mCRC患者的数据。使用单变量和多变量Cox比例风险回归模型评估PTR对生存的影响。然后，我们评估了先前接受或未接受PTR的患者中PTL与总生存之间的关联。进行倾向评分以匹配队列。
纳入了466例患者。共有153例（32.8%）患者有未切除的同步性mCRC，313例（67.2%）患者有切除的同步性mCRC。右结肠癌、左结肠癌和直肠癌患者的数量分别为174例（37.3%）、203例（43.6%）和89例（19.1%）。在多变量分析中，只有PTL、PTR、肝和/或肺转移灶的切除以及在整个治疗过程中使用奥沙利铂、表皮生长因子受体（EGFR）抑制剂或贝伐单抗与较高的总生存率相关。根据PTR和PTL进行的生存评估发现，PTR改善了左侧和右侧mCRC的预后。使用加权倾向评分证实了结果。
在mCRC中，无论PTL如何，PTR似乎都能使患者获得更高的生存率。
