Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan.
Int J Colorectal Dis. 2024 Oct 25;39(1):171. doi: 10.1007/s00384-024-04745-1.
Metastatic colorectal cancer (mCRC) poses a clinical challenge and requires a combination of systemic therapy and conversion surgery. Although first-line chemotherapy and targeted therapy are considered the standard treatments for mCRC, the role of primary tumor resection (PTR) in asymptomatic synchronous mCRC with unresectable metastatic lesion after initial therapy remains relatively underexplored.
A retrospective review was conducted from January 2015 to January 2021, involving 74 patients with synchronous mCRC who received bevacizumab plus FOFIRI as first-line systemic therapy. All 74 patients had unresectable metastatic lesions confirmed through multidisciplinary team discussion. Patient characteristics, PTR data, and radiotherapy (RT) and overall survival (OS) outcomes were analyzed. The patients were categorized into a "PTR" group and a "No PTR" group and then further stratified into "4A," "4B," and "4C" subgroups based on the initial mCRC stage. Additionally, four subgroups-namely "PTR( +)/RT( +)," "PTR( +)/RT( -)," "PTR( -)/RT( +)," and "PTR( -)/RT( -)"-were formed to assess the combined effects of PTR and RT.
The median OS for all the patients was 23.8 months (20.5-27.1 months). The "PTR" group exhibited a significantly higher median OS of 25.9 months (21.3-30.5 months) compared with 21.4 months (15.8-27.1 months) in the "No PTR" group (p = 0.048). Subgroup analyses revealed a trend of improved survival with PTR in patients with stage IVA and IVB; however, the results were not statistically significant (p = 0.116 and 0.493, respectively). A subgroup analysis of PTR and RT combinations revealed no significant difference in median OS rates.
For asymptomatic mCRC with synchronous unresectable distant metastasis, PTR following first-line therapy with bevacizumab plus FOLFIRI may provide a potential survival benefit, particularly in stage IVA/IVB patients compared with stage IVC patients. Additionally, RT for primary tumor did not provide an additional OS benefit in mCRC with unresectable metastasis. A prospective randomized trial with a larger sample size is essential to further elucidate the role of PTR in this context.
转移性结直肠癌（mCRC）是一个临床挑战，需要系统治疗和转化手术相结合。虽然一线化疗和靶向治疗被认为是 mCRC 的标准治疗方法，但对于初始治疗后存在不可切除转移病灶的无症状同步 mCRC 患者，原发肿瘤切除术（PTR）的作用仍相对未被充分探索。
本研究回顾性分析了 2015 年 1 月至 2021 年 1 月期间接受贝伐珠单抗联合 FOLFIRI 作为一线系统治疗的 74 例同步 mCRC 患者。所有 74 例患者均通过多学科团队讨论确认存在不可切除的转移病灶。分析了患者特征、PTR 数据以及放疗（RT）和总生存（OS）结局。根据初始 mCRC 分期，将患者分为“PTR”组和“非 PTR”组，并进一步分为“4A”“4B”和“4C”亚组。此外，还形成了四个亚组，即“PTR（+）/RT（+）”“PTR（+）/RT（-）”“PTR（-）/RT（+）”和“PTR（-）/RT（-）”，以评估 PTR 和 RT 的联合效应。
所有患者的中位 OS 为 23.8 个月（20.5-27.1 个月）。“PTR”组的中位 OS 明显更高，为 25.9 个月（21.3-30.5 个月），而“非 PTR”组为 21.4 个月（15.8-27.1 个月）（p=0.048）。亚组分析显示，在 IVA 期和 IVB 期患者中，PTR 有改善生存的趋势，但差异无统计学意义（p=0.116 和 0.493）。PTR 和 RT 联合亚组分析显示，中位 OS 率无显著差异。
对于一线贝伐珠单抗联合 FOLFIRI 治疗后存在不可切除远处转移的无症状 mCRC，PTR 可能提供潜在的生存获益，尤其是与 IVC 期患者相比，IVA/IVB 期患者获益更为明显。此外，对于不可切除转移的 mCRC，原发肿瘤的 RT 并未带来额外的 OS 获益。需要更大样本量的前瞻性随机试验来进一步阐明 PTR 在这种情况下的作用。
