Prognostic Value of Resection of Primary Tumor in Patients with Stage IV Colorectal Cancer: Retrospective Analysis of Two Randomized Studies and a Review of the Literature
Prognostic Value of Resection of Primary Tumor in Patients with Stage IV Colorectal Cancer: Retrospective Analysis of Two Randomized Studies and a Review of the Literature
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原发肿瘤切除对 IV 期结直肠癌患者的预后价值：两项随机研究的回顾性分析及文献综述
DOI：
10.1007/s13193-012-0157-z
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发表时间：
2012
影响因子：
0.5
通讯作者：
M. Koopman
中科院分区：
文献类型：
--
作者：
S. Venderbosch;J. Wilt;S. Teerenstra;O. Loosveld;A. Bochove;H. Sinnige;G. Creemers;M. Tesselaar;L. Mol;C. Punt;M. Koopman
BackgroundIn转移性结直肠癌（mCRC）与无症状的原发性肿瘤的患者，有没有共识的指示切除的原发tumor.MethodsA回顾性分析的结果进行IV期结直肠癌（CRC）患者与或不切除的原发性肿瘤治疗的III期CAIRO和CAIRO 2研究。文献回顾performed.ResultsIn的CAIRO和CAIRO 2研究，258和289例患者进行了原发性肿瘤切除术和141和159例，分别没有。在CAIRO研究中，观察到切除组的中位总生存期和无进展生存期显著优于非切除组，分别为16.7 vs. 11.4个月[P< 0.0001，风险比（HR）0.61]和6.7 vs. 5.9个月（P= 0.004; HR 0.74）。在CAIRO 2研究中，切除组的中位总生存期和无进展生存期也明显优于非切除组，分别为20.7个月和13.4个月（P< 0.0001; HR 0.65），10.5个月和7.8个月（P= 0.014; HR 0.78）。这些差异在多变量分析中仍然显着。我们的审查确定了22个非随机研究，其中大部分表现出改善生存的mCRC患者进行切除的原发tumor.ConclusionsOur结果以及文献数据表明，切除原发肿瘤是生存期IV期CRC患者的预后因素。这些结果的潜在偏倚保证了对这种情况下原发性肿瘤切除价值的前瞻性研究;目前正在计划此类研究。
BackgroundIn patients with metastatic colorectal cancer (mCRC) with an asymptomatic primary tumor, there is no consensus on the indication for resection of the primary tumor.MethodsA retrospective analysis was performed on the outcome of stage IV colorectal cancer (CRC) patients with or without resection of the primary tumor treated in the phase III CAIRO and CAIRO2 studies. A review of the literature was performed.ResultsIn the CAIRO and CAIRO2 studies, 258 and 289 patients had undergone a primary tumor resection and 141 and 159 patients had not, respectively. In the CAIRO study, a significantly better median overall survival and progression-free survival was observed for the resection compared to the nonresection group, with 16.7 vs. 11.4 months [P< 0.0001, hazard ratio (HR) 0.61], and 6.7 vs. 5.9 months (P= 0.004; HR 0.74), respectively. In the CAIRO2 study, median overall survival and progression-free survival were also significantly better for the resection compared to the nonresection group, with 20.7 vs. 13.4 months (P< 0.0001; HR 0.65) and 10.5 vs. 7.8 months (P= 0.014; HR 0.78), respectively. These differences remained significant in multivariate analyses. Our review identified 22 nonrandomized studies, most of which showed improved survival for mCRC patients who underwent resection of the primary tumor.ConclusionsOur results as well as data from literature indicate that resection of the primary tumor is a prognostic factor for survival in stage IV CRC patients. The potential bias of these results warrants prospective studies on the value of resection of primary tumor in this setting; such studies are currently being planned.