Palliative surgery for colorectal cancer with peritoneal metastasis: a propensity-score matching analysis
Palliative surgery for colorectal cancer with peritoneal metastasis: a propensity-score matching analysis
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DOI：
10.1007/s00595-016-1402-9
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发表时间：
2017-02
期刊：
影响因子：
2.5
通讯作者：
S. Jeong;Y. Yoon;Jung Bok Lee;J. L. Lee;C. W. Kim;I. Park;Seok-Byung Lim;C. Yu;J. C. Kim
中科院分区：
文献类型：
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作者：
S. Jeong;Y. Yoon;Jung Bok Lee;J. L. Lee;C. W. Kim;I. Park;Seok-Byung Lim;C. Yu;J. C. Kim
目的结直肠癌（CRC）患者腹膜转移（PM）与不良预后相关。我们进行了这项研究，以评估原发肿瘤姑息性切除（PR）是否能改善PM-CRC患者的总生存期（OS）。方法回顾性分析结直肠癌患者的前瞻性资料。根据日语对PM的分类，PM被分为三个亚组。使用倾向评分模型来比较接受PR （PR组）和未接受PR （NR组）的患者的预后。结果在1909例转移性结直肠癌患者中，309例（16%）仅发生腹膜转移，其中255例接受姑息性手术（R2）的患者是我们分析的对象：PR组161例，NR组94例。PR组的中位生存期明显长于NR组（23个月vs 11个月，P< 0.001）。PR组患者PM的广泛性较小，接受姑息性化疗的比例高于NR组（P< 0.001）。在69对倾向评分匹配的Cox多变量分析中，PR导致的OS明显长于NR（风险比0.496,95%可信区间0.268-0.919，P= 0.025）。结论：我们的研究结果表明，当PM-CRC患者的整体情况允许更积极的治疗方法时，PR比NR产生更好的OS。
PurposePeritoneal metastasis (PM) in patients with colorectal cancer (CRC) is associated with poor prognosis. We conducted this study to assess whether palliative resection (PR) of the primary tumor improved the overall survival (OS) of patients with PM-CRC.MethodsWe analyzed retrospectively, data collected prospectively from patients with CRC. PM was categorized into three subgroups according to the Japanese classification of PM. A propensity‐score model was used to compare the outcomes of patients who underwent PR (PR group) and those who did not [non‐resection (NR) group].ResultsAmong 1909 patients with metastatic CRC, 309 (16 %) had only peritoneal metastases and 255 of these patients who underwent palliative surgery (R2) were the subjects of our analysis: 161 in the PR group and 94 in the NR group. Median OS was significantly longer in the PR group than in the NR group (23 vs. 11 months,P< 0.001). Patients in the PR group had less extensive PM and a higher rate of receiving palliative chemotherapy than those in the NR group (P< 0.001). In a Cox multivariate analysis of 69 propensity‐score matched pairs, PR resulted in significantly longer OS than NR (hazard ratio 0.496, 95 % confidence interval 0.268–0.919,P= 0.025).ConclusionsOur results show that PR resulted in better OS than NR for patients with PM-CRC, when their overall condition permitted a more aggressive approach.