Division of Medical Oncology, Defne Hospital, Antakya, Hatay, Turkey.
Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey.
PLoS One. 2021 Nov 8;16(11):e0259622. doi: 10.1371/journal.pone.0259622. eCollection 2021.
The aim of the study is to reveal the contribution of complete response (CR) to treatment to overall survival (OS) in patients with unresectable metastatic colorectal cancer. In addition, to evaluate progression-free survival (PFS) in patients who attained CR to treatment and to examine the clinicopathologic features of the patient group with CR.
This article is a retrospective chart review. Patients diagnosed with metastatic colorectal cancer were divided into two groups. The systemic treatment was compared with the patients who received a full response according to the Response Evaluation Criteria in Solid Tumors (RECIST1.1) and those who did not attain CR (progression partial response and stable response) in terms of both PFS and OS data, and the effect of attaining CR to treatment on prognosis was evaluated.
A total of 222 patients were included in the study. 202 of 222 patients could be evaluated in terms of complete response. All data from their files were tabulated and analyzed retrospectively. The mean age of diagnosis of the study group was 60.13 ± 12.52 years. The total number of patients who attained CR to treatment was 31 (15.3%); 171 (84.6%) patients did not attain CR. Patients who had a CR had longer median PFS times than patients who did not have a CR (15.2 vs. 7.4 months, P<0.001). Patients who had CR had longer median survival times than patients who did not have a CR (39.2 vs. 16.9 months, P<0.001). In subgroup patients who underwent primary surgery, the number of patients who attained CR was statistically higher compared with the number of patients who did not attain CR (p<0.001). Complete response was less common in the presence of liver metastasis and bone metastasis (p = 0.041 and p = 0.046, respectively), had a negative prognostic effect. In other words, 89.1% of patients with liver metastasis, 100.0% of patients with bone metastasis, and 88.7% of those who died did not have a CR to the treatment. According to multivariate analysis, CR to treatment, primary surgery, first-line chemotherapy (combination compared with fluoropyrimidine), and no bone metastasis were found to be predictors for OS.
Providing CR with systemic treatment in patients with unresectable metastatic colorectal cancer (mCRC) contributes to prognosis. The primary resection in our secondary acquisitions from the study, the number of metastatic regions and the combination therapy regimens also contributed to the prognosis.
本研究旨在揭示不可切除转移性结直肠癌患者完全缓解（CR）对总生存期（OS）的治疗贡献。此外，评估达到治疗 CR 的患者的无进展生存期（PFS），并检查具有 CR 的患者组的临床病理特征。
这是一项回顾性图表审查。将诊断为转移性结直肠癌的患者分为两组。根据实体瘤反应评估标准 1.1（RECIST1.1），比较接受全身治疗的患者与未达到 CR（部分缓解和稳定缓解）的患者的 PFS 和 OS 数据，评估达到治疗 CR 对预后的影响。
共纳入 222 例患者。222 例患者中有 202 例可评估完全缓解。对其所有病历资料进行制表并回顾性分析。研究组的平均诊断年龄为 60.13±12.52 岁。达到治疗 CR 的患者总数为 31 例（15.3%）；171 例（84.6%）患者未达到 CR。达到 CR 的患者的中位 PFS 时间长于未达到 CR 的患者（15.2 比 7.4 个月，P<0.001）。达到 CR 的患者的中位总生存期长于未达到 CR 的患者（39.2 比 16.9 个月，P<0.001）。在接受初次手术的亚组患者中，达到 CR 的患者数量明显高于未达到 CR 的患者（p<0.001）。存在肝转移和骨转移的患者中 CR 较少（p=0.041 和 p=0.046），具有负预后影响。换句话说，89.1%的肝转移患者、100.0%的骨转移患者和 88.7%的死亡患者未达到治疗 CR。根据多变量分析，治疗 CR、初次手术、一线化疗（联合治疗与氟嘧啶）和无骨转移是 OS 的预测因素。
为不可切除转移性结直肠癌（mCRC）患者提供全身性治疗 CR 有助于改善预后。在我们从研究中获得的二次采集的主要切除术、转移部位的数量和联合治疗方案也有助于预后。
