原发肿瘤切除术对不可切除转移的 IV 期结直肠癌患者死亡率的影响：一项多中心回顾性队列研究。

Impact of Primary Tumor Resection on Mortality in Patients with Stage IV Colorectal Cancer with Unresectable Metastases: A Multicenter Retrospective Cohort Study.

机构信息

Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo, Kyoto, 606-8501, Japan.

Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Koriyama, Japan.

出版信息

World J Surg. 2021 Oct;45(10):3230-3239. doi: 10.1007/s00268-021-06233-x. Epub 2021 Jul 5.

DOI:10.1007/s00268-021-06233-x

PMID:34223985

Abstract

BACKGROUND

Primary tumor resection (PTR) before commencing systemic chemotherapy in patients with stage IV colorectal cancer and unresectable metastases (mCRC) remains controversial. This study aimed to assess whether PTR before systemic chemotherapy is associated with mortality in mCRC patients, after adjusting for confounding factors, such as the severity of the primary tumor and metastatic lesions.

METHODS

We analyzed hospital-based cancer registries from nine designated cancer hospitals in Fukushima Prefecture, Japan. Patients were divided into two groups (PTR and non-PTR), based on whether PTR was performed as initial therapy for mCRC or not. The primary outcome was all-cause mortality. Kaplan-Meier survival analysis was performed, and survival estimates were compared using the log-rank test. Adjusted hazard ratios were calculated using Cox regression to adjust for confounding factors. All tests were two-sided; P-values < 0.05 were considered statistically significant.

RESULTS

Between 2008 and 2015, 616 mCRC patients were included (PTR: 414 [67.2%]; non-PTR: 202 [32.8%]). The median follow-up time was 18.0 (interquartile range [IQR]: 8.4-29.7) months, and 492 patients (79.9%) died during the study period. Median overall survival in the PTR and non-PTR groups was 23.9 (IQR: 12.2-39.9) and 12.3 (IQR: 6.2-23.8) months, respectively (P < 0.001, log-rank test). PTR was significantly associated with improved overall survival (adjusted hazard ratio: 0.51; 95% confidence interval: 0.42-0.64, P < 0.001).

CONCLUSIONS

PTR before systemic chemotherapy in patients with mCRC was associated with improved survival.

摘要

背景

在患有 IV 期结直肠癌和不可切除转移（mCRC）的患者中，在开始全身化疗之前进行原发肿瘤切除术（PTR）仍然存在争议。本研究旨在评估在考虑到原发肿瘤和转移灶严重程度等混杂因素后，全身化疗前 PTR 是否与 mCRC 患者的死亡率相关。

方法

我们分析了来自日本福岛县 9 家指定癌症医院的基于医院的癌症登记处。根据 PTR 是否作为 mCRC 的初始治疗进行，将患者分为两组（PTR 组和非 PTR 组）。主要结局是全因死亡率。进行 Kaplan-Meier 生存分析，并使用对数秩检验比较生存估计。使用 Cox 回归计算调整后的危险比，以调整混杂因素。所有检验均为双侧检验；P 值<0.05 为统计学显著。

结果

在 2008 年至 2015 年期间，共纳入 616 例 mCRC 患者（PTR：414 [67.2%]；非 PTR：202 [32.8%]）。中位随访时间为 18.0（四分位距 [IQR]：8.4-29.7）个月，研究期间有 492 例患者（79.9%）死亡。PTR 组和非 PTR 组的中位总生存期分别为 23.9（IQR：12.2-39.9）和 12.3（IQR：6.2-23.8）个月（P<0.001，对数秩检验）。PTR 与总生存期的改善显著相关（调整后的危险比：0.51；95%置信区间：0.42-0.64，P<0.001）。