Department of Anorectal Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China.
Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Cancer Control. 2023 Jan-Dec;30:10732748231180056. doi: 10.1177/10732748231180056.
Previous studies have provided evidence that primary site surgery can improve the prognosis of rectal cancer patients, even in those with advanced age and distant metastasis, though results have been inconsistent. The current study aims to determine if all rectal cancer patients are likely to benefit from surgery in terms of overall survival.
This study examined the impact of primary site surgery on the prognosis of rectal cancer patients diagnosed between 2010 and 2019 using multivariable Cox regression analysis. The study also stratified patients by age group, M stage, chemotherapy, radiotherapy, and number of distant metastatic organs. The propensity score matching method was used to balance observed covariates between patients who received and did not receive surgery. The Kaplan-Meier method was used to analyze the data, and the log-rank test was used to determine differences between patients who did and did not undergo surgery.
The study included 76,941 rectal cancer patients, with a median survival of 81.0 months (95% CI: 79.2-82.8 months). Of these patients, 52,360 (68.1%) received primary site surgery, and they tended to be younger, have higher differentiated grade, earlier T, N, M stage, and lower rates of bone, brain, lung, and liver metastasis, chemotherapy, and radiotherapy than those without surgery. Multivariable Cox regression analysis revealed that surgery had a protective effect on the prognosis of rectal cancer patients, including those with advanced age, distant metastasis, and multiple organ metastasis, but not in patients with four organ metastases. The results were also confirmed using propensity score matching.
Not all rectal cancer patients could benefit from the surgery on the primary site, especially the patients with more than four distant metastases. The results could help the clinicians to tailor targeted treatment regimens and provide a guideline for making surgical decisions.
既往研究已证实原发灶手术可改善直肠癌患者的预后，即使在高龄和远处转移患者中也是如此，但结果并不一致。本研究旨在确定所有直肠癌患者在总体生存方面是否都可能从手术中获益。
本研究采用多变量 Cox 回归分析，评估了 2010 年至 2019 年间诊断的直肠癌患者原发灶手术对其预后的影响。本研究还按年龄组、M 分期、化疗、放疗和远处转移器官数量对患者进行分层。采用倾向评分匹配法平衡接受手术和未接受手术患者的观察性协变量。采用 Kaplan-Meier 法分析数据，并用 log-rank 检验比较接受手术和未接受手术患者的差异。
本研究纳入了 76941 例直肠癌患者，中位生存时间为 81.0 个月（95%CI：79.2-82.8 个月）。其中 52360 例（68.1%）接受了原发灶手术，这些患者倾向于更年轻、分化程度更高、肿瘤分期更早（T、N、M 分期更早）、远处转移率更低、接受化疗和放疗的比例更低。多变量 Cox 回归分析显示，手术对直肠癌患者的预后有保护作用，包括高龄、远处转移和多个器官转移的患者，但对转移器官数大于 4 的患者则无此作用。倾向评分匹配后也得到了相同的结果。
并非所有直肠癌患者都能从原发灶手术中获益，尤其是转移器官数大于 4 个的患者。这些结果有助于临床医生制定个体化的治疗方案，并为手术决策提供指导。
