Doah Ki Yoon, Shin Ui Sup, Jeon Byong Ho, Cho Sang Sik, Moon Sun Mi
Department of Surgery, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea.
Ann Coloproctol. 2021 Apr;37(2):94-100. doi: 10.3393/ac.2020.09.15.1. Epub 2021 Apr 30.
This study was conducted to evaluate the effectiveness of primary tumor resection (PTR) in asymptomatic colorectal cancer (CRC) patients with unresectable metastases using the inverse probability of treatment weighting (IPTW) method to minimize selection bias.
We selected 146 patients diagnosed with stage IV CRC with unresectable metastasis between 2001 and 2018 from our institutional database. In a multivariate logistic regression model using the patients' baseline covariates associated with PTR, we applied the IPTW method based on a propensity score and performed a weighted Cox proportional regression analysis to estimate survival according to PTR.
Upfront PTR was performed in 98 patients, and no significant differences in baseline factors were detected. The upweighted median survival of the PTR group was 18 months and that of the non-PTR group was 15 months (P = 0.15). After applying the IPTW, the PTR was still insignificant in the univariate Cox regression (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.5-1.21). However, in the multivariate weighted Cox regression with adjustment for other covariates, the PTR showed a significantly decreased risk of cancer-related death (HR, 0.61; 95% CI, 0.40-0.94).
In this study, we showed that asymptomatic CRC patients with unresectable metastases could gain a survival benefit from upfront PTR by analysis with the IPTW method. However, randomized controlled trials are mandatory.
本研究旨在使用治疗权重逆概率（IPTW）方法评估原发性肿瘤切除（PTR）对无症状且有不可切除转移灶的结直肠癌（CRC）患者的有效性，以尽量减少选择偏倚。
我们从机构数据库中选取了2001年至2018年间诊断为IV期CRC且有不可切除转移灶的146例患者。在使用与PTR相关的患者基线协变量的多变量逻辑回归模型中，我们基于倾向评分应用IPTW方法，并进行加权Cox比例回归分析以根据PTR估计生存率。
98例患者接受了 upfront PTR，未检测到基线因素有显著差异。PTR组的加权中位生存期为18个月，非PTR组为15个月（P = 0.15）。应用IPTW后，PTR在单变量Cox回归中仍无统计学意义（风险比[HR]，0.26；95%置信区间[CI]，–0.5–1.21）。然而，在对其他协变量进行调整的多变量加权Cox回归中，PTR显示癌症相关死亡风险显著降低（HR，0.61；95%CI，0.40–0.94）。
在本研究中，我们表明通过IPTW方法分析，无症状且有不可切除转移灶的CRC患者可从 upfront PTR中获得生存益处。然而，随机对照试验是必不可少的。
