Improved Survival in Metastatic Colorectal Cancer Is Associated With Adoption of Hepatic Resection and Improved Chemotherapy
Improved Survival in Metastatic Colorectal Cancer Is Associated With Adoption of Hepatic Resection and Improved Chemotherapy
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DOI：
10.1200/jco.2008.20.5278
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发表时间：
2009-08-01
影响因子：
45.3
通讯作者：
McWilliams, Robert R.
中科院分区：
文献类型：
--
作者：
Kopetz, Scott;Chang, George J.;McWilliams, Robert R.
目的氟尿嘧啶/甲酰四氢叶酸作为转移性结直肠癌 (CRC) 的唯一疗法可提供 8 至 12 个月的总生存期。随着转移性疾病手术切除的增加和新化疗的开发，间接证据表明，尽管增量增益尚未量化，但一般人群的患者预后正在改善。方法我们对 1990 年至 2006 年在两个学术中心接受治疗的新诊断转移性 CRC 患者进行了回顾性回顾。标志性分析评估了诊断年份和肝切除与总生存率的关系。监测流行病学和最终结果 (SEER) 数据库的附加生存分析评估了 1990 年至 2005 年的类似人群。结果 在此期间，2,470 名诊断时患有转移性 CRC 的患者在这两个机构接受了主要治疗。 1990年至1997年诊断的患者的中位总生存期为14.2个月，1998年至2000年、2001年至2003年和2004年至2006年诊断的患者的中位总生存期分别增加至18.0、18.6和29.3个月。同样，5 年总生存率从最早时期的 9.1% 增加到 2001 年至 2003 年的 19.2%。1998 年至 2004 年结果的改善得益于肝切除术的增加，其中 20% 的患者接受了肝切除术。 2004 年至 2006 年的改善暂时与新化疗药物的使用增加有关。在 SEER 登记中，49,459 名确定的患者的总生存率在最近一段时间内也有所增加。 结论 转移性 CRC 结局的显着改善似乎与选定患者中肝切除术使用的连续增加（1998 年至 2006 年）以及药物治疗的进步（2004 年至 2006 年）有关。 J 临床肿瘤学杂志 27：3677-3683。 (C) 2009 年美国临床肿瘤学会
PurposeFluorouracil/leucovorin as the sole therapy for metastatic colorectal cancer (CRC) provides an overall survival of 8 to 12 months. With an increase in surgical resections of metastatic disease and development of new chemotherapies, indirect evidence suggests that outcomes for patients are improving in the general population, although the incremental gain has not yet been quantified.MethodsWe performed a retrospective review of patients newly diagnosed with metastatic CRC treated at two academic centers from 1990 through 2006. Landmark analysis evaluated the association of diagnosis year and liver resection with overall survival. Additional survival analysis of the Surveillance Epidemiology and End Results (SEER) database evaluated a similar population from 1990 through 2005.ResultsTwo thousand four hundred seventy patients with metastatic CRC at diagnosis received their primary treatment at the two institutions during this time period. Median overall survival for those patients diagnosed from 1990 to 1997 was 14.2 months, which increased to 18.0, 18.6, and 29.3 months for patients diagnosed in 1998 to 2000, 2001 to 2003, and 2004 to 2006, respectively. Likewise, 5-year overall survival increased from 9.1% in the earliest time period to 19.2% in 2001 to 2003. Improved outcomes from 1998 to 2004 were a result of an increase in hepatic resection, which was performed in 20% of the patients. Improvements from 2004 to 2006 were temporally associated with increased utilization of new chemotherapeutics. In the SEER registry, overall survival for the 49,459 identified patients also increased in the most recent time period.ConclusionProfound improvements in outcome in metastatic CRC seem to be associated with the sequential increase in the use of hepatic resection in selected patients (1998 to 2006) and advancements in medical therapy (2004 to 2006). J Clin Oncol 27: 3677-3683. (C) 2009 by American Society of Clinical Oncology