Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
Clin Transl Oncol. 2024 Jan;26(1):269-277. doi: 10.1007/s12094-023-03250-1. Epub 2023 Jun 24.
This study aims to assess and compare the extent to which preoperative chemotherapy prior to CRS improves survival in patients diagnosed with CRCPM.
We included 251 patients from 2012 to 2019 in our center. Inverse probability of treatment weighting (IPTW) analysis was used to minimize the selection bias. Survival analysis was performed to compare the survival outcomes. Multivariate Cox regression analysis was conducted to identify prognostic factors.
The baseline characteristics were well balanced using IPTW (standardized mean difference < 0.1). Preoperative chemotherapy cannot significantly improve overall survival (HR, 1.03; 95% CI 0.71-1.49; P = 0.88). In subgroup analysis, we found that intestinal obstruction after preoperative chemotherapy significantly reduced survival (HR, 2.25; 95% CI 1.01-5.03; P = 0.048), while in the upfront surgery group, intestinal obstruction had no impact on prognosis.
For CRCPM patients treated with CRS, preoperative chemotherapy does not seem to prolong overall survival. Furthermore, the emergence of intestinal obstruction after chemotherapy may compromise the effectiveness of treatment, resulting in a worse prognosis. This finding has important clinical implications for treatment decisions.
本研究旨在评估和比较术前化疗在接受 CRS 的 CRCPM 患者中对生存的改善程度。
我们纳入了 2012 年至 2019 年在我们中心治疗的 251 例患者。采用逆概率治疗加权（IPTW）分析来最小化选择偏倚。进行生存分析以比较生存结果。进行多变量 Cox 回归分析以确定预后因素。
使用 IPTW 很好地平衡了基线特征（标准化均差 < 0.1）。术前化疗不能显著改善总生存率（HR，1.03；95%CI，0.71-1.49；P=0.88）。亚组分析发现，术前化疗后肠梗阻显著降低了生存率（HR，2.25；95%CI，1.01-5.03；P=0.048），而在直接手术组中，肠梗阻对预后没有影响。
对于接受 CRS 治疗的 CRCPM 患者，术前化疗似乎不能延长总生存率。此外，化疗后出现肠梗阻可能会影响治疗效果，导致预后更差。这一发现对治疗决策具有重要的临床意义。
