The Impact of Primary Tumor Location in Synchronous Metastatic Colorectal Cancer: Differences in Metastatic Sites and Survival
The Impact of Primary Tumor Location in Synchronous Metastatic Colorectal Cancer: Differences in Metastatic Sites and Survival
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DOI：
10.1245/s10434-019-08100-5
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发表时间：
2019-12-02
影响因子：
3.7
通讯作者：
de Wilt, Johannes H. W.
中科院分区：
文献类型：
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作者：
Brouwer, Nelleke P. M.;Van der Kruijssen, Dave E. W.;de Wilt, Johannes H. W.
目的探讨原发肿瘤部位之间生存率的差异，着重探讨转移部位在同步转移性结直肠癌（mCRC）中的作用。方法从荷兰癌症登记处检索1989年至2014年间诊断为同步性mCRC的患者数据。通过原发肿瘤位置（右结肠（RCC）、左结肠（LCC）和直肠）分析相对生存率和相对超额风险（RER）。根据原发肿瘤位置报告转移部位。分析了合并转移部位和单个转移部位的生存率。结果共有36,297例患者纳入本研究。原发肿瘤部位之间转移部位差异显著，RCC、LCC和直肠癌患者中仅肝脏转移的比例分别为43%、54%和52%（p < 0.001）。腹膜转移在RCC患者中最常见（33%），肺转移在直肠癌患者中最常见（28%）。无论转移部位如何，RCC患者的生存率均低于LCC（RER 0.81，95% CI 0.78-0.83）和直肠癌（RER 0.73，95% CI 0.71-0.76）。RCC的生存劣势仍然存在，即使是在仅因肝脏疾病而行直肠癌切除术的病例中（LCC：RER 0.66，95% CI 0.57-0.76;直肠癌：RER 0.84，95% CI 0.66-1.06）。结论：本研究显示，原发肿瘤部位之间的相对生存率在同步性结直肠癌中存在显著差异，这只能部分解释为不同的转移部位。我们的研究结果支持RCC，LCC和直肠癌应被视为同步性mCRC的不同实体的概念。
Purpose We explored differences in survival between primary tumor locations, hereby focusing on the role of metastatic sites in synchronous metastatic colorectal cancer (mCRC). Methods Data for patients diagnosed with synchronous mCRC between 1989 and 2014 were retrieved from the Netherlands Cancer registry. Relative survival and relative excess risks (RER) were analyzed by primary tumor location (right colon (RCC), left colon (LCC), and rectum). Metastatic sites were reported per primary tumor location. Survival was analyzed for metastatic sites combined and for single metastatic sites. Results In total, 36,297 patients were included in this study. Metastatic sites differed significantly between primary tumor locations, with liver-only metastases in 43%, 54%, and 52% of RCC, LCC, and rectal cancer patients respectively (p < 0.001). Peritoneal metastases were most prevalent in RCC patients (33%), and lung metastases were most prevalent in rectal cancer patients (28%). Regardless of the location of metastases, patients with RCC had a worse survival compared with LCC (RER 0.81, 95% CI 0.78-0.83) and rectal cancer (RER 0.73, 95% CI 0.71-0.76). The survival disadvantage for RCC remained present, even in cases with metastasectomy for liver-only disease (LCC: RER 0.66, 95% CI 0.57-0.76; rectal cancer: RER 0.84, 95% CI 0.66-1.06). Conclusions This study showed significant differences in relative survival between primary tumor locations in synchronous mCRC, which can only be partially explained by distinct metastatic sites. Our findings support the concept that RCC, LCC and rectal cancer should be considered distinct entities in synchronous mCRC.