Treatment of Stage IV Colon Cancer in the United States: A Patterns-of-Care Analysis
Treatment of Stage IV Colon Cancer in the United States: A Patterns-of-Care Analysis
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DOI：
10.6004/jnccn.2020.7533
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发表时间：
2020-06-01
影响因子：
13.4
通讯作者：
Charlton, Mary E.
中科院分区：
文献类型：
--
作者：
Gao, Xiang;Kahl, Amanda R.;Charlton, Mary E.
背景资料：国家指南推荐化疗作为IV期结肠癌的主要治疗方法，原发性肿瘤切除术（PTR）保留给有症状的原发性或可治愈疾病的患者。本研究的目的是描述IV期结肠癌患者接受的治疗方式，并确定与这些治疗相关的患者，肿瘤和医院水平因素。方法：2014年诊断为IV期结肠癌的患者从SEER护理模式倡议中提取。治疗分为仅化疗、仅PTR、PTR +化疗和无/未知。结果如下：加权病例总数为3，336例; 17%的患者仅接受PTR，23%仅接受化疗，41%接受PTR +化疗，17%未接受治疗。在多变量分析中，与单纯化疗相比，PTR +化疗与已婚有关（比值比[OR]，1.9），有肠梗阻（OR，2.55），并且具有穿孔（OR，2.29），而年龄较大（OR，5.95），医疗补助覆盖范围（OR，2.46），较高的T分期（OR，3.51）和较高的N分期（OR，6.77）仅与PTR相关。未接受治疗的患者没有更多的合并症或更严重的疾病负担，但更可能是老年人（OR，3.91）和非西班牙裔非洲裔美国人（OR，2.92;所有P<0.05）。在较小的非学术性医院接受治疗与PTR（+/-化疗）相关。结论：PTR被纳入大多数IV期结肠癌患者的治疗方案中，并且与较小的非学术医院相关。努力改善指南的实施可能对这些医院以及非西班牙裔非洲裔美国人和老年人群有益。
Background: National guidelines recommend chemotherapy as the mainstay of treatment for stage IV colon cancer, with primary tumor resection (PTR) reserved for patients with symptomatic primary or curable disease. The aims of this study were to characterize the treatment modalities received by patients with stage IV colon cancer and to determine the patient-, tumor-, and hospital-level factors associated with those treatments. Methods: Patients diagnosed with stage IV colon cancer in 2014 were extracted from the SEER Patterns of Care initiative. Treatments were categorized into chemotherapy only, PTR only, PTR + chemotherapy, and none/unknown. Results: The total weighted number of cases was 3,336; 17% of patients received PTR only, 23% received chemotherapy only, 41% received PTR + chemotherapy, and 17% received no treatment. In multivariable analyses, compared with chemotherapy only, PTR + chemotherapy was associated with being married (odds ratio [OR], 1.9), having bowel obstruction (OR, 2.55), and having perforation (OR, 2.29), whereas older age (OR, 5.95), Medicaid coverage (OR, 2.46), higher T stage (OR, 3.51), and higher N stage (OR, 6.77) were associated with PTR only. Patients who received no treatment did not have more comorbidities or more severe disease burden but were more likely to be older (OR, 3.91) and non-Hispanic African American (OR, 2.92; all P< .05). Treatment at smaller, nonacademic hospitals was associated with PTR (+/- chemotherapy). Conclusions: PTR was included in the treatment regimen for most patients with stage IV colon cancer and was associated with smaller, nonacademic hospitals. Efforts to improve guideline implementation may be beneficial in these hospitals and also in non-Hispanic African American and older populations.