Zhou Yuan, Wang Dan, Tan Fengbo, Zhou Zhongyi, Zhao Lilan, Güngör Cenap, Pei Qian, Li Yuqiang, Liu Wenxue
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
J Cancer. 2022 Apr 4;13(7):2171-2178. doi: 10.7150/jca.70894. eCollection 2022.
The metastatic site seems to represent a malignancy with a different biological characteristic. Radiotherapy, as a successful, well-tolerated, cost-effective and time-efficient intervention, is able to provide clear benefits for the treatment of locally advanced rectal cancer and has become an essential component of palliative oncology care. The real-world effect of radiotherapy on the survival outcomes of metastatic rectal cancer (mRC) patients might do exist and was worth exploring. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database in this retrospective analysis. The statistical methods included Pearson's chi-square test, Log-rank test, Cox regression model and propensity score matching (PSM). The multivariable Cox regression displayed that radiotherapy may not be used as a prognostic factor for mRC (p=0.057). However, radiotherapy may be associated with the prognosis if the metastatic site was excluded from the multivariate analysis (p<0.001). Radiotherapy seemed to fail to improve OS before PSM (p<0.001) and after PSM without the metastatic site as a matching factor (p<0.001). Nevertheless, there was no significant survival difference between radiotherapy and non-radiotherapy cohort after PSM with the metastatic site as a matching factor (p=0.057). All of M1a rectal cancer patients appear to obtain survival benefit from radiotherapy without the impact of PSM (p<0.001). Notwithstanding, radiotherapy was associated with improved OS of patients with rectal liver-limited metastasis (p=0.023) and did not appear to provide survival benefit for rectal lung-limited (p=0.386) and other-limited metastasis (p=0.385). Both of M1b mRC with and without liver metastasis did not seem to obtain survival benefit from radiotherapy. Carefully selected data from the SEER database suggested that radiotherapy appears to improve overall survival only in patients with rectal liver-limited metastasis.
转移部位似乎代表了一种具有不同生物学特征的恶性肿瘤。放射治疗作为一种成功、耐受性良好、具有成本效益且高效的干预措施，能够为局部晚期直肠癌的治疗带来明显益处，并已成为姑息肿瘤护理的重要组成部分。放射治疗对转移性直肠癌（mRC）患者生存结局的实际影响可能确实存在，值得探索。在这项回顾性分析中，数据从监测、流行病学和最终结果（SEER）数据库中提取。统计方法包括Pearson卡方检验、对数秩检验、Cox回归模型和倾向得分匹配（PSM）。多变量Cox回归显示，放射治疗可能不能用作mRC的预后因素（p = 0.057）。然而，如果在多变量分析中排除转移部位，放射治疗可能与预后相关（p < 0.001）。在PSM之前（p < 0.001）以及以转移部位不作为匹配因素的PSM之后（p < 0.001），放射治疗似乎未能改善总生存期（OS）。尽管如此，以转移部位作为匹配因素的PSM后，放射治疗组与非放射治疗组之间在生存方面没有显著差异（p = 0.057）。所有M1a期直肠癌患者似乎都能从放射治疗中获得生存益处，不受PSM的影响（p < 0.001）。尽管如此，放射治疗与直肠肝转移局限患者的OS改善相关（p = 0.023），而对于直肠肺转移局限（p = 0.386）和其他转移局限（p = 0.385）患者似乎未提供生存益处。伴有和不伴有肝转移的M1b期mRC患者似乎都不能从放射治疗中获得生存益处。从SEER数据库中精心挑选的数据表明，放射治疗似乎仅能改善直肠肝转移局限患者的总生存期。
