Primary Tumor Resection Is Associated with Improved Survival in Stage IV Colorectal Cancer: An Instrumental Variable Analysis.
Primary Tumor Resection Is Associated with Improved Survival in Stage IV Colorectal Cancer: An Instrumental Variable Analysis.
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原发肿瘤切除与 IV 期结直肠癌生存率提高相关：工具变量分析
DOI：
10.1038/srep16516
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发表时间：
2015-11-13
影响因子：
4.6
通讯作者：
Mao Y
中科院分区：
文献类型：
--
作者：
Xu H;Xia Z;Jia X;Chen K;Li D;Dai Y;Tao M;Mao Y
原发肿瘤切除术（PTR）被推荐用于无法切除的IV期结直肠癌（CRC）患者，他们的症状与原发肿瘤相关。然而，PTR对无症状患者的生存益处是有争议的。我们调查了过去二十年来美国不可切除的IV期CRC患者PTR率的变化以及PTR对生存率的贡献。从1988年1月1日至2010年12月31日，44514例诊断为不可切除的IV期结直肠癌患者进行了PTR或未进行PTR的临床病理因素和长期生存率的比较。采用多变量Cox回归和工具变量法确定影响生存率的独立因素。在44514例不能切除的IV期结直肠癌患者中，27931例（62.7%）接受了PTR。在1988年和2010年，PTR的年诊断率从74.4%下降到50.2%，PTR和非PTR患者的中位总生存期均有所增加。工具变量分析显示，PTR与不可切除的IV期CRC患者更好的总体、癌症特异性和其他原因生存率相关。
Primary tumor resection (PTR) is recommended for patients with unresectable stage IV colorectal cancer (CRC) who present with symptoms related to their primary tumor. However, the survival benefit of PTR for asymptomatic patients is controversial. We investigated the change in PTR rates and the contribution of PTR to survival in patients with unresectable stage IV CRC over the past two decades in the United States. Clinicopathological factors and long-term survival were compared for 44 514 patients diagnosed with unresectable stage IV CRC from January 1, 1988, through December 31, 2010, who had or had not undergone PTR. Multivariable Cox regression and the instrumental variable method were used to identify independent factors for survival. Of the 44 514 patients with unresectable stage IV CRC, 27 931 (62.7%) had undergone PTR. The annual rate of PTR decreased from 74.4% to 50.2% diagnosed in 1988 and 2010 and the median overall survival increased for both PTR and non-PTR patients. Instrumental variable analyses revealed that PTR was associated with better overall, cancer-specific and other-cause survival of patients with unresectable stage IV CRC.