接受肝和/或肺转移灶切除的IV期结直肠癌患者的预后因素：一项基于人群的队列研究

Prognostic Factors in Stage IV Colorectal Cancer Patients With Resection of Liver and/or Pulmonary Metastases: A Population-Based Cohort Study.

作者信息

Peng Panxin, Luan Yusong, Sun Peng, Wang Liming, Zeng Xufeng, Wang Yangyang, Cai Xuhao, Ren Peide, Yu Yonggang, Liu Qi, Ma Haoyue, Chang Huijing, Song Bolun, Fan Xiaohua, Chen Yinggang

机构信息

Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.

Department of Clinical Medicine, Changsha Medical University, Changsha, China.

出版信息

Front Oncol. 2022 Mar 15;12:850937. doi: 10.3389/fonc.2022.850937. eCollection 2022.

DOI:10.3389/fonc.2022.850937

PMID:35372009

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8964936/

Abstract

IMPORTANCE

Currently, surgical resection of distant metastatic lesions has become the preferred treatment for select colorectal cancer (CRC) patients with liver metastasis (LM) and/or pulmonary metastasis (PM). Metastasectomy is the most common curative method. However, evidence of the factors affecting the prognosis of CRC patients after resection of LM and/or PM is still insufficient.

OBJECTIVE

To explore the prognostic factors of CRC patients with LM and/or PM who have undergone resection of metastatic tumors and to provide reliable selection factors for surgical treatment in patients affected by LM and/or PM from CRC.

METHODS

The SEER database was used to identify eligible CRC LM and/or PM patients who underwent resection of the primary tumor and distant metastases from January 1, 2010, to December 31, 2018. The Kaplan-Meier method was used to calculate survival, and comparisons were performed using the log-rank test for univariate analysis. A Cox proportional hazards regression model was used to identify prognostic factors for the multivariate analysis. The outcomes included overall survival (OS) and cancer-specific survival (CSS).

RESULTS

A total of 3,003 eligible colorectal cancer patients with LM and/or PM were included in this study. The 3-year and 5-year OS rates were 53% and 33.6%, respectively, and the 3-year and 5-year CSS rates were 54.2% and 35.3%, respectively. In the adjusted multivariate analysis, age < 65 years (OS: p=0.002, CSS: p=0.002) was associated with better long-term outcomes, and primary tumors located on the left side of the colon (OS: p=0.004, CSS: p=0.006) or rectum (OS: p=0.004, CSS: p=0.006), T3 stage (OS: p<0.001, CSS: p<0.001), number of regional lymph nodes examined ≥ 12 (OS: p<0.001, CSS: p=0.001), and CRC LM (OS: p<0.001, CSS: p<0.001) were positive prognostic factors for survival after resection of metastatic tumors.

CONCLUSION

Age < 65 years is associated with better long-term outcomes in colorectal cancer patients with LM and/or PM, analogously to the left sided primary tumor, T3 stage, number of regional lymph nodes examined ≥ 12 and liver metastases.

摘要

重要性

目前，手术切除远处转移病灶已成为部分伴有肝转移（LM）和/或肺转移（PM）的结直肠癌（CRC）患者的首选治疗方法。转移灶切除术是最常见的治愈性方法。然而，关于影响CRC患者LM和/或PM切除术后预后因素的证据仍然不足。

目的

探讨接受转移瘤切除的CRC伴LM和/或PM患者的预后因素，并为受CRC的LM和/或PM影响的患者手术治疗提供可靠的选择因素。

方法

利用监测、流行病学与最终结果（SEER）数据库，识别2010年1月1日至2018年12月31日期间接受原发性肿瘤和远处转移灶切除的符合条件的CRC伴LM和/或PM患者。采用Kaplan-Meier方法计算生存率，并使用对数秩检验进行单因素分析比较。采用Cox比例风险回归模型识别多因素分析的预后因素。结局指标包括总生存期（OS）和癌症特异性生存期（CSS）。

结果

本研究共纳入3003例符合条件的伴有LM和/或PM的结直肠癌患者。3年和5年OS率分别为53%和33.6%，3年和5年CSS率分别为54.2%和35.3%。在调整后的多因素分析中，年龄<65岁（OS：p = 0.002，CSS：p = 0.002）与更好的长期结局相关，结肠左侧（OS：p = 0.004，CSS：p = 0.006）或直肠（OS：p = 0.004，CSS：p = 0.006）的原发性肿瘤、T3期（OS：p<0.001，CSS：p<0.001）、检查的区域淋巴结数量≥12个（OS：p<0.001，CSS：p = 0.001）以及CRC伴LM（OS：p<0.001，CSS：p<0.001）是转移瘤切除术后生存的阳性预后因素。