Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
Oncologist. 2023 Jan 18;28(1):48-58. doi: 10.1093/oncolo/oyac209.
Overall survival advantage of chemotherapy before versus after metastasectomy of liver or lung lesion is not clear for colon cancer with synchronous liver or lung metastasis.
Adults 20 years or older with primary colon cancer and single organ metastatic disease either in the liver or lung at diagnosis were identified between 2010 and 2015 through the National Cancer Database (NCDB). Patients were categorized into 2 cohorts: pre-operative/peri-operative chemotherapy (neoadjuvant -[NAC]) or post-operative chemotherapy (adjuvant [AC]). Survivals and factors associated with were compared between the 2 groups.
A total of 3038 patients with colon cancer with liver or lung metastases were identified. The percentage of patients receiving NAC had steadily increased from 12.29% to 28.31%, mostly in academic programs. On multivariate analysis, patients who received NAC had an overall survival advantage in the non-academic setting whereas no advantage is seen in the patients treated in the academic settings. The median overall survival for patients receiving NAC and AC was 47.24 months and 38.08 months, respectively. Factors associated with overall survival advantage in NAC patients treated in non-academic programs included age 20-49 years, CEA value of >30, right-sided colon primary, liver metastasis, and clear resection margins.
Metastatic colon cancer with single organ liver or lung lesions benefits from neoadjuvant chemotherapy, especially in -non-academic settings. The overall survival advantage in this setting has not been shown before.
对于同时患有肝或肺转移的结肠癌患者，化疗在转移灶切除术之前或之后是否具有总体生存优势尚不清楚。
2010 年至 2015 年期间，通过国家癌症数据库（NCDB）确定了患有原发性结肠癌且在诊断时肝或肺中只有单一器官转移灶的 20 岁或 20 岁以上的成年人患者。将患者分为 2 个队列：术前/围手术期化疗（新辅助-[NAC]）或术后化疗（辅助-[AC]）。比较两组患者的生存率和相关因素。
共确定了 3038 例患有肝或肺转移的结肠癌患者。接受 NAC 的患者比例从 12.29%稳步增加到 28.31%，主要是在学术项目中。多变量分析显示，在非学术环境中接受 NAC 的患者具有总体生存优势，而在学术环境中治疗的患者则没有优势。接受 NAC 和 AC 的患者的中位总生存时间分别为 47.24 个月和 38.08 个月。在非学术环境中接受 NAC 治疗的患者中，与总体生存优势相关的因素包括年龄 20-49 岁、CEA 值>30、右半结肠癌、肝转移和明确的切缘。
患有单一器官肝或肺转移的转移性结肠癌受益于新辅助化疗，尤其是在非学术环境中。在此环境中，总体生存优势以前尚未显示。
