Association Between Palliative Resection of the Primary Tumor and Overall Survival in a Population-Based Cohort of Metastatic Colorectal Cancer Patients
Association Between Palliative Resection of the Primary Tumor and Overall Survival in a Population-Based Cohort of Metastatic Colorectal Cancer Patients
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DOI：
10.1245/s10434-014-3797-0
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发表时间：
2014-11-01
影响因子：
3.7
通讯作者：
Cheung, Winson Y.
中科院分区：
文献类型：
--
作者：
Gresham, Gillian;Renouf, Daniel J.;Cheung, Winson Y.
姑息性切除原发肿瘤对转移性结直肠癌（mCRC）患者预后的影响尚不清楚。本研究的主要目的是评估以人群为基础的mCRC队列中姑息性切除与总生存率（OS）之间的关系。对2006年至2008年间诊断为mCRC并在BC癌症机构接受治疗的患者进行了回顾。采用Kaplan-Meier法进行生存分析。拟合Cox比例风险回归模型，评估姑息性切除与OS的关系，同时控制潜在混杂因素，如年龄、性别、东部肿瘤合作组状态、癌胚胎抗原水平、原发肿瘤位置、转移部位和数量、接受全身治疗。为了调整姑息性切除组和未行姑息性切除组之间的异质性和选择偏倚，还进行了倾向评分匹配分析。共纳入517例患者。在这些病例中，378例（73%）患者接受了原发肿瘤的姑息性切除，139例（27%）患者没有接受姑息性切除。共有327例患者（63%）接受了姑息性化疗。与不切除相比，姑息性切除与更长的中位生存期（17.9个月vs 7.9个月）以及更有利的未调整和调整死亡风险比（HR 0.46, 95% CI 0.37-0.56, p < 0.0001; HR 0.56, 95% CI 0.40-0.78, p = 0.0007）相关。在倾向评分匹配分析中，切除组的预后也更有利（p = 0.0017）。在这组mCRC患者中，姑息性切除原发肿瘤与改善OS相关。
The impact of palliative resection of the primary tumor on outcomes in patients with metastatic colorectal cancer (mCRC) remains unclear. The primary objective of this study was to evaluate the association between palliative resection and overall survival (OS) in a population-based cohort of mCRC.Patients diagnosed with mCRC between 2006 and 2008 and treated at the BC Cancer Agency were reviewed. Survival analysis was conducted using Kaplan-Meier methods. Cox proportional hazards regression models were fitted to evaluate the relationship between palliative resection and OS while controlling for potential confounders, such as age, gender, Eastern Cooperative Oncology Group status, carcinoembryonic antigen level, primary tumor location, metastatic site and number, and receipt of systemic therapy. To adjust for the heterogeneity and selection bias between the group that underwent palliative resection and the group that did not, a propensity score-matched analysis was also performed.A total of 517 patients were included. Among these cases, 378 (73 %) patients underwent palliative resection of their primary tumor, and 139 (27 %) patients did not. A total of 327 patients (63 %) were treated with palliative chemotherapy. Palliative resection was associated with a longer median OS (17.9 vs. 7.9 months) and more favorable unadjusted and adjusted hazard ratios (HRs) for death (HR 0.46, 95 % CI 0.37-0.56, p < 0.0001 and HR 0.56, 95 % CI 0.40-0.78, p = 0.0007, respectively) when compared with no resection. In a propensity score-matched analysis, prognosis was also more favorable in the resected group (p = 0.0017).In this cohort of mCRC patients, palliative resection of the primary tumor was associated with improved OS.