Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Medicina (Kaunas). 2023 Jul 28;59(8):1384. doi: 10.3390/medicina59081384.
: Colorectal cancer (CRC) bone metastasis (BM), particularly synchronous metastasis, is infrequent and has a poor prognosis. Radical surgery for CRC with BM is challenging, and chemotherapy is the standard treatment. However, it is unclear whether combining chemotherapy with primary tumor resection (PTR) yields greater survival benefits than chemotherapy alone, as no relevant reports exist. : The Surveillance, Epidemiology, and End Results (SEER) database provided data on 1662 CRC patients with bone metastasis between 2010 and 2018, who were divided into two groups: chemotherapy combined with PTR and chemotherapy alone. Survival distributions were compared using the log-rank test, and survival estimates were obtained using the Kaplan-Meier method. A Cox proportional multivariate regression analysis was conducted to estimate the survival benefit of chemotherapy combined with PTR while controlling for additional prognostic factors. : The chemotherapy only group consisted of 1277 patients (76.8%), while the chemotherapy combined with PTR group contained 385 patients (23.2%). Patients who received chemotherapy combined with PTR had a significantly higher 1-year survival rate (60.7%) and 2-year survival rate (32.7%) compared to those who only received chemotherapy (43.8% and 18.4%, respectively; < 0.0001). Independent prognostic factors identified by Cox proportional analysis were age, location of the primary tumor, type of tumor, M stage, metastasectomy and PTR. Patients who received chemotherapy combined with PTR had a significantly improved prognosis (HR 0.586, 95% CI 0.497-0.691, < 0.0001). All subgroups demonstrated a survival advantage for patients who received chemotherapy in combination with PTR. : Our findings suggest that patients with BM from CRC may benefit from chemotherapy combined with PTR. Our analysis also identified age, location of the primary tumor, type of tumor, M stage, metastasectomy, and PTR as independent prognostic risk factors for CRC patients with synchronous BM.
结直肠癌（CRC）骨转移（BM），特别是同步转移，并不常见且预后较差。对于有 BM 的 CRC 进行根治性手术具有挑战性，化疗是标准治疗方法。然而，联合化疗与原发肿瘤切除（PTR）是否比单纯化疗能带来更大的生存获益尚不清楚，因为没有相关报道。
我们利用美国监测、流行病学和最终结果（SEER）数据库，收集了 2010 年至 2018 年间 1662 例 CRC 伴骨转移患者的数据，这些患者被分为化疗联合 PTR 组和单纯化疗组。采用对数秩检验比较生存分布，采用 Kaplan-Meier 法获得生存估计值。采用 Cox 比例风险回归分析，在控制其他预后因素的情况下，估计化疗联合 PTR 的生存获益。
单纯化疗组有 1277 例患者（76.8%），化疗联合 PTR 组有 385 例患者（23.2%）。与单纯化疗组相比，接受化疗联合 PTR 治疗的患者具有更高的 1 年生存率（60.7%比 43.8%，P<0.0001）和 2 年生存率（32.7%比 18.4%，P<0.0001）。Cox 比例风险分析确定的独立预后因素为年龄、原发肿瘤位置、肿瘤类型、M 分期、转移灶切除术和 PTR。与单纯化疗组相比，接受化疗联合 PTR 治疗的患者预后显著改善（HR 0.586，95%CI 0.497-0.691，P<0.0001）。所有亚组均显示化疗联合 PTR 治疗患者的生存获益。
我们的研究结果表明，CRC 伴 BM 的患者可能从化疗联合 PTR 中获益。我们的分析还确定了年龄、原发肿瘤位置、肿瘤类型、M 分期、转移灶切除术和 PTR 是 CRC 同步 BM 患者的独立预后危险因素。
