Ⅳ期结直肠癌不同手术策略对患者预后的影响

The prognostic impact ofⅣstage colorectal cancer patients accepted different surgical strategies

目的Ⅳ期结直肠癌患者的预后较差,手术策略的选择对Ⅳ期结直肠癌患者一直存有争议,本研究拟通过大数据样本系统评估Ⅳ期结直肠癌不同手术策略对患者预后的影响。方法通过筛选,从美国国家癌症研究所的监测、流行病学和最终结果数据库(National Cancer Institute′s Surveillance,Epidemiology,and End Results dataset,SEER)中获得13077例2010~2015年诊断为Ⅳ期结直肠癌的患者信息。将获取的数据分为以下四组:均未手术组、原发手术组、转移手术组、均行手术组,分析四种手术策略的患者预后情况,并进一步探究化疗与否对手术策略的疗效影响。结果四个研究组均获得中位生存时间,分别为11、18、20、31个月(P<0.001)。COX多因素分析表明,相比于均未手术组,原发手术组、转移手术组、均行手术组患者预后更好,HR分别为0.640(95%CI:0.605~0.677;P<0.001)、0.592(95%CI:0.424~0.828;P=0.002)、0.371(95%CI:0.343~0.401;P<0.001)。在无(未知)进行化疗的患者中,均行手术组患者(MST=6个月)预后好于原发手术组患者(MST=5个月;P<0.001);转移手术组患者(MST=4个月)预后与均未手术组患者(MST=2个月;P=0.236)相似。在进行化疗的患者中得到不同的结果,均行手术组患者(MST=36个月)预后好于原发手术组患者(MST=25个月;P<0.001);而转移手术组患者(MST=22个月)预后好于均未手术组患者(MST=16个月;P=0.015),并且化疗患者(MST=25个月)预后明显好于无(未知)化疗患者(MST=4个月;P<0.001)。结论Ⅳ期结直肠癌手术治疗患者与未进行手术患者相比,具有更好的生存获益情况。化疗因素也会影响患者的预后情况,在无(未知)化疗的患者中,应避免单一转移部位手术;而经历化疗的患者中,转移性肿瘤的切除可以获得更好的获益情况。同时进一步证明了化疗对Ⅳ期结直肠癌患者的疗效。

Purpose The prognosis ofⅣstage colorectal cancer patients is poor,and it is controversial to select adaptive surgical strategy for them.This work is aimed to systematically evaluate the prognostic impact ofⅣstage colorectal cancer patients who accepted different surgical strategies based on a large population.Methods We selected 13077 patients diagnosed withⅣstage colorectal cancer in 2010~2015 from National Cancer Institute′s Surveillance,Epidemiology,and End Result s(SEER)dataset.They were divided into four groups as follows:no surgery group,primary site surgery group,metastatic site surgery group,all surgery group,and we analyzed the prognosis of patients with four surgical strategies and further explored the effect of chemotherapy on surgical strategy.Results The median survival time(MST)of the four groups were 11,18,20,31 months,respectively(P<0.001).The Cox proportional hazards model showed that primary site surgery group,metastatic site surgery group,all surgery group had a better prognosis than no surgery group,with hazard ratios of 0.640(95%CI,0.605~0.677;P<0.001),0.592(95%CI,0.424~0.828;P=0.002),0.371(95%CI,0.343~0.401;P<0.001),respectively.And in the no(unknown)chemotherapy population,all surgery group(MST=6 months)had a survival benefit compared with primary site surgery group(MST=5 months,P<0.001);metastatic site surgery group(MST=4 months)had a similar survival with no surgery group(MST=2 months,P=0.236).In the chemotherapy population,different results were attained,all surgery group(MST=36 months)had a survival benefit compared with primary site surgery group(MST=25 months,P<0.001);metastatic site surgery group(MST=22 months)had a better survival than no surgery group(MST=16 months,P=0.015).Besides,the chemotherapy group(MST=25 months)had a better survival compared with no(unknown)chemotherapy group(MST=4 months,P<0.001).Conclusion Patients who underwent surgery for stage IV colorectal cancer had better overall survival than the no surgery group.The selection of chemotherapy factor would affected patients′prognosis,in the no(unknown)chemotherapy population,we should avoid metastatic site surgery,however,in the chemotherapy population,metastatic site surgery would bring a better survival.And it proved that chemotherapy is good for patients with stageⅣcolorectal cancer.