Use of surgery among elderly patients with stage IV colorectal cancer
Use of surgery among elderly patients with stage IV colorectal cancer
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DOI：
10.1200/jco.2004.10.218
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发表时间：
2004-09-01
影响因子：
45.3
通讯作者：
Schrag, D
中科院分区：
文献类型：
--
作者：
Temple, LKF;Hsieh, L;Schrag, D
目的IV期结直肠癌（CRC）患者手术切除原发肿瘤的作用是有争议的。本研究的目的是评估大于或等于65岁的IV期CRC患者在美国人群为基础的cohol.Patients和MethodsWe使用的监测，流行病学，和最终结果-医疗保险链接的数据库，以评估癌症治疗的模式为9，011医疗保险受益人提出的IV期CRC从1991年至1999年，根据患者在诊断后4个月内是否接受了原发性癌症导向手术（CDS）或未接受CDS对患者进行分类。使用其他治疗方式，包括膀胱切除术，化疗和放疗，进行了评估，在关系是否属于CDS或无CDS group.Results72%（6,469 9,011）的患者接受CDS，其30天的术后死亡率为10%。左侧或直肠病变患者、75岁以上患者、黑人和社会经济地位较低的患者不太可能接受CDS;但即使在75岁以上的患者中，CDS率也为69%（4，909例中的3，378例）。相比之下，化疗的使用不太常见（47%的患者患有CDS，31%的患者没有）。转移瘤切除术少见;只有3.9%的患者接受这些手术在任何时候从诊断到死亡。ConclusionPalliative切除原发肿瘤往往是美国老年患者进行IV期结直肠癌。鉴于全身化疗疗效的改善，这种实践模式值得重新评估。(C)2004年，美国临床肿瘤学会。
PurposeThe role of surgery to remove the primary tumor among patients with stage IV colorectal cancer (CRC) is controversial. The purpose of this study was to evaluate surgical practice patterns for patients greater than or equal to 65 years of age with stage IV CRC in a US population-based cohort.Patients and MethodsWe used the Surveillance, Epidemiology, and End Results-Medicare-linked database to evaluate the patterns of cancer treatment for 9,011 Medicare beneficiaries presenting with stage IV CRC from 1991 to 1999, Patients were categorized according to whether they had primary-cancer-directed surgery (CDS) or no CDS within 4 months of diagnosis. The use of other treatment modalities, including metastasectomy, chemotherapy, and radiation, was evaluated in relationship to whether patients belonged to the CDS or no CDS group.ResultsSeventy-two percent (6,469 of 9,011) of patients received CDS, and their 30-day postoperative mortality was 10%. Patients with left-sided or rectal lesions, patients older than age 75 years, blacks, and those of lower socioeconomic status were less likely to undergo CDS; but even among those older than age 75, the CDS rate was 69% (3,378 of 4,909). In contrast, chemotherapy use was less common (47% for patients who had CDS and 31% for those who did not). Metastasectomy was rare; only 3.9% of patients underwent these operations at any point from diagnosis to death.ConclusionPalliative resection of the primary tumor is often performed for elderly US patients with stage IV colorectal cancer. This practice pattern merits re-evaluation, given the improvement in the efficacy of systemic chemotherapy. (C) 2004 by American Society of Clinical Oncology.