原发灶切除联合化疗对Ⅳ期结直肠癌的预后影响

doi:10.3969/j.issn.1009-976X.2023.03.003

摘要/Abstract

摘要： 目的原发灶切除对Ⅳ期结直肠癌患者的生存获益一直存有争议,本研究主要探讨原发灶切除联合化疗对Ⅳ期结直肠癌患者的预后影响。方法通过收集SEER数据库2010~2015年诊断为Ⅳ期的结直肠癌患者共4108例,根据治疗方式分为无原发灶切除+无化疗组、单纯原发灶切除组、单纯化疗组、原发灶切除+化疗组。采用Kaplan-Meier法绘制生存曲线,Log-rank法比较不同治疗方式的生存差异,应用Cox比例风险回归模型评估Ⅳ期结直肠癌的预后因素。结果年龄≥60岁、黑种人、右半结肠、分化程度差、伴有淋巴结转移、多发转移、CEA升高是Ⅳ期结直肠癌预后的危险因素,而原发灶切除、化疗是Ⅳ期结直肠癌患者预后的保护因素。在四种治疗方式中,原发灶切除+化疗组的预后最好。结论不论是ⅣA期还是ⅣB期结直肠癌,与单纯全身化疗相比,原发灶切除联合化疗可以明显提高患者的生存时间。

关键词: 结直肠癌, Ⅳ期;, 原发灶切除, 化疗, 预后分析

Abstract: Objective The survival benefit of primary tumor resection on patients with stage Ⅳ colorectal cancer has been controversial. This study aimed to investigate the prognostic impact of primary tumor resection combined with chemotherapy on patients with stage Ⅳ colorectal cancer. Methods A total of 4108 patients diagnosed with stage Ⅳ colorectal cancer in the SEER database from 2010 to 2015 were enrolled and divided into no primary tumor resection + no chemotherapy group, primary resection alone group, chemotherapy alone group, and primary tumor resection + chemotherapy group according to the treatment methods. The Kaplan-Meier method was used to draw survival curves, the Log-rank method was used to compare the survival differences among different treatment methods, and the Cox proportional risk regression model was applied to assess the prognostic factors of stage Ⅳ colorectal cancer. Results Age ≥60 years, Blacks, right hemicolon, poor differentiation, with lymph node metastasis, multiple metastasis, and elevated CEA were the risk factors for prognosis of stage Ⅳ colorectal cancer, while primary tumor resection and chemotherapy were the protective factors for prognosis of stage Ⅳ colorectal cancer patients. Among the four treatment modalities, the prognosis of the primary tumor resection+chemotherapy group was the best. Conclusion In both stage ⅣA and ⅣB colorectal cancers, primary tumor resection combined with chemotherapy significantly improves patient survival compared to systemic chemotherapy alone.

Key words: colorectal cancer, primary tumor resection, chemotherapy, stage Ⅳ, prognosis

中图分类号:

周华彬, 刘玉兰, 王钟昌, 利民, 郑超. 原发灶切除联合化疗对Ⅳ期结直肠癌的预后影响[J]. 岭南现代临床外科, 2023, 23(03): 220-229.

ZHOU Hua-bin, LIU Yu-lan, WANG Zhong-chang, LI Min, ZHENG Chao. Prognostic impact of primary tumor resection combined with chemotherapy on stage Ⅳ colorectal cancer[J]. Lingnan Modern Clinics In Surgery, 2023, 23(03): 220-229.

参考文献

[1] Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] Cao M, Li H, Sun D, et al.Cancer burden of major cancers in China: A need for sustainable actions[J]. Cancer Commun, 2020, 40(5): 205-210.
[3] 郑莹, 王泽洲. 全球结直肠癌流行数据解读[J]. 中华流行病学杂志, 2021, 42(1): 149-152.
[4] 曹奇华, 许燕波, 徐栋. 结直肠癌免疫检查点治疗的研究进展[J]. 肿瘤防治研究, 2021, 48(3): 229-233.
[5] 贺思佳, 黄倩, 李琦. 晚期结直肠癌化疗及靶向治疗进展[J]. 世界临床药物, 2020, 41(11): 844-849.
[6] 米迷, 翁姗姗, 陆德珉, 等. 2021年晚期结直肠癌治疗研究进展[J]. 实用肿瘤杂志, 2022, 37(1): 23-28.
[7] 薛卫成, 顾晋. 第7版结直肠癌TNM分期(2010)的变化及意义[J]. 中华外科杂志, 2010(21): 1605-1606.
[8] Ishihara S, Nishikawa T, Tanaka T, et al.Benefit of primary tumor resection in stage IV colorectal cancer with unresectable metastasis: a multicenter retrospective study using a propensity score analysis[J]. Int J Colorectal Dis, 2015, 30(6): 807-812.
[9] Nitsche U, Stöß C, Stecher L, et al.Meta-analysis of outcomes following resection of the primary tumour in patients presenting with metastatic colorectal cancer[J]. Br J Surg, 2018, 105(7): 784-796.
[10] Ahmed S, Fields A, Pahwa P, et al.Surgical Resection of Primary Tumor in Asymptomatic or Minimally Symptomatic Patients With Stage IV Colorectal Cancer: A Canadian Province Experience[J]. Clin Colorectal Cancer, 2015, 14(4): e41-e47.
[11] Huang Y, Ge K, Fu G, et al.Efficacy of Primary Tumor Resection in Metastatic Colorectal Cancer[J]. Med Sci Monit, 2020, 26.
[12] Tarantino I, Warschkow R, Worni M, et al.Prognostic Relevance of Palliative Primary Tumor Removal in 37, 793 Metastatic Colorectal Cancer Patients[J]. Ann Surg, 2015, 262(1): 112-120.
[13] Zhijun Y, Shanshan W, Chenyang Y, et al.CSCO guidelines for colorectal cancer version 2022: Updates and discussions[J]. Chin J Cancer Res, 2022, 34(02): 67-70.
[14] Benson AB, Venook AP, Al-Hawary MM, et al.Colon Cancer, Version 2. 2021, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2021, 19(3): 329-359.
[15] Benson AB, Venook AP, Al-Hawary MM, et al.NCCN Guidelines Insights: Rectal Cancer, Version 6. 2020[J]. J Natl Compr Canc Netw, 2020, 18(7): 806-815.
[16] Yoshino T, Arnold D, Taniguchi H, et al.Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS[J]. Ann Oncol, 2018, 29(1): 44-70.
[17] Glynne-Jones R, Wyrwicz L, Tiret E, et al.Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2018, 29(Suppl 4): v263.
[18] Franke AJ, Skelton WP, Starr JS, et al.Immunotherapy for Colorectal Cancer: A Review of Current and Novel Therapeutic Approaches[J]. JNCI: J Natl Cancer Inst, 2019, 111(11): 1131-1141.
[19] Piawah S, Venook AP.Targeted therapy for colorectal cancer metastases: A review of current methods of molecularly targeted therapy and the use of tumor biomarkers in the treatment of metastatic colorectal cancer[J]. Cancer, 2019, 125(23): 4139-4147.
[20] Maroney S, de Paz CC, Reeves ME, et al. Benefit of Surgical Resection of the Primary Tumor in Patients Undergoing Chemotherapy for Stage IV Colorectal Cancer with Unresected Metastasis[J]. J Gastrointest Surg, 2018, 22(3): 460-466.
[21] Gulack BC, Nussbaum DP, Keenan JE, et al.Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer Without Metastasectomy Is Associated With Improved Overall Survival Compared With Chemotherapy/Radiation Therapy Alone[J]. Dis Colon Rectum, 2016, 59(4): 299-305.
[22] Hu C, Bailey CE, You YN, et al.Time Trend Analysis of Primary Tumor Resection for Stage IV Colorectal Cancer[J]. JAMA Surg, 2015, 150(3): 245.
[23] 赵力, 侯丁丁, 王建方, 等. 转移性结直肠癌原发灶切除的共识和争议[J]. 中华普通外科杂志, 2020, 35(12): 981-984.
[24] Patel S, Chang GJ.Primary Tumor Resection in Metastatic Colorectal Cancer: Please Pass the Salt[J]. JAMA Oncol, 2015, 1(9): 1213-1214.
[25] 王自强, 魏明天. 不可切除的Ⅳ期转移性结直肠癌无症状原发灶切除的价值[J]. 中国普外基础与临床杂志, 2014, 21(11): 1325-1328.
[26] T Lam-Boer J, Van der Geest LG, Verhoef C, et al. Palliative resection of the primary tumor is associated with improved overall survival in incurable stage IV colorectal cancer: A nationwide population-based propensity-score adjusted study in the Netherlands[J]. Int J Cancer, 2016, 139(9): 2082-2094.
[27] Kanemitsu Y, Shitara K, Mizusawa J, et al.A randomized phase III trial comparing primary tumor resection plus chemotherapy with chemotherapy alone in incurable stage IV colorectal cancer: JCOG1007 study (iPACS)[J]. J Clin Oncol, 2020, 38(4_suppl): 7.
[28] Alawadi Z, Phatak UR, Hu C, et al.Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer[J]. Cancer, 2017, 123(7): 1124-1133.
[29] 卓长华, 陈功, Park EJ, 等. 原发灶切除在无症状的、同时性的、转移灶不可切除的结直肠癌患者中的作用:一项多中心随机对照试验[J]. 结直肠肛门外科, 2020, 26(5): 617-619.