原发灶切除联合化疗对Ⅳ期结直肠癌的预后影响

Prognostic impact of primary tumor resection combined with chemotherapy on stageⅣcolorectal cancer

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。

Objective The survival benefit of primary tumor resection on patients with stageⅣcolorectal cancer has been controversial.This study aimed to investigate the prognostic impact of primary tumor resection combined with chemotherapy on patients with stageⅣcolorectal cancer.Methods A total of 4108 patients diagnosed with stageⅣcolorectal 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 stageⅣcolorectal 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 stageⅣcolorectal cancer,while primary tumor resection and chemotherapy were the protective factors for prognosis of stageⅣcolorectal cancer patients.Among the four treatment modalities,the prognosis of the primary tumor resection+chemotherapy group was the best.Conclusion In both stageⅣA andⅣB colorectal cancers,primary tumor resection combined with chemotherapy significantly improves patient survival compared to systemic chemotherapy alone.