Impact on survival benefits of asymptomatic primary tumor resection after bevacizumab plus FOLFIRI as first-line therapy for patients with metastatic colorectal cancer with synchronous unresectable metastasis.

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yen-Cheng Chen, Tsung-Kun Chang, Wei-Chih Su, Yung-Sung Yeh, Po-Jung Chen, Peng-Jen Huang, Po-Hsiang Yang, Hsiang-Lin Tsai, Jaw-Yuan Wang, Ching-Wen Huang
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引用次数: 0

Abstract

Background: Metastatic colorectal cancer (mCRC) poses a clinical challenge and requires a combination of systemic therapy and conversion surgery. Although first-line chemotherapy and targeted therapy are considered the standard treatments for mCRC, the role of primary tumor resection (PTR) in asymptomatic synchronous mCRC with unresectable metastatic lesion after initial therapy remains relatively underexplored.

Materials: A retrospective review was conducted from January 2015 to January 2021, involving 74 patients with synchronous mCRC who received bevacizumab plus FOFIRI as first-line systemic therapy. All 74 patients had unresectable metastatic lesions confirmed through multidisciplinary team discussion. Patient characteristics, PTR data, and radiotherapy (RT) and overall survival (OS) outcomes were analyzed. The patients were categorized into a "PTR" group and a "No PTR" group and then further stratified into "4A," "4B," and "4C" subgroups based on the initial mCRC stage. Additionally, four subgroups-namely "PTR( +)/RT( +)," "PTR( +)/RT( -)," "PTR( -)/RT( +)," and "PTR( -)/RT( -)"-were formed to assess the combined effects of PTR and RT.

Results: The median OS for all the patients was 23.8 months (20.5-27.1 months). The "PTR" group exhibited a significantly higher median OS of 25.9 months (21.3-30.5 months) compared with 21.4 months (15.8-27.1 months) in the "No PTR" group (p = 0.048). Subgroup analyses revealed a trend of improved survival with PTR in patients with stage IVA and IVB; however, the results were not statistically significant (p = 0.116 and 0.493, respectively). A subgroup analysis of PTR and RT combinations revealed no significant difference in median OS rates.

Conclusion: For asymptomatic mCRC with synchronous unresectable distant metastasis, PTR following first-line therapy with bevacizumab plus FOLFIRI may provide a potential survival benefit, particularly in stage IVA/IVB patients compared with stage IVC patients. Additionally, RT for primary tumor did not provide an additional OS benefit in mCRC with unresectable metastasis. A prospective randomized trial with a larger sample size is essential to further elucidate the role of PTR in this context.

贝伐单抗加 FOLFIRI 作为转移性结直肠癌同步不可切除转移灶患者一线治疗后无症状原发肿瘤切除对生存获益的影响。
背景:转移性结直肠癌(mCRC)是一项临床挑战,需要结合全身治疗和转换手术。尽管一线化疗和靶向治疗被认为是 mCRC 的标准治疗方法,但对于初始治疗后无法切除转移病灶的无症状同步 mCRC,原发肿瘤切除术(PTR)的作用仍相对缺乏探索:从2015年1月至2021年1月进行了一项回顾性研究,涉及74例接受贝伐单抗加FOFIRI作为一线系统治疗的同步mCRC患者。所有74名患者均通过多学科团队讨论确认了不可切除的转移病灶。对患者特征、PTR数据、放疗(RT)和总生存期(OS)结果进行了分析。患者被分为 "PTR "组和 "无PTR "组,然后根据最初的mCRC分期进一步分为 "4A"、"4B "和 "4C "亚组。此外,为了评估 PTR 和 RT 的联合作用,还成立了四个亚组,即 "PTR( +)/RT( +)"、"PTR( +)/RT( -)"、"PTR( -)/RT( +) "和 "PTR( -)/RT( -)":所有患者的中位OS为23.8个月(20.5-27.1个月)。PTR "组的中位OS为25.9个月(21.3-30.5个月),明显高于 "无PTR "组的21.4个月(15.8-27.1个月)(P = 0.048)。亚组分析显示,在 IVA 和 IVB 期患者中,PTR 有提高生存率的趋势;但结果无统计学意义(p = 0.116 和 0.493)。对PTR和RT组合进行的亚组分析显示,中位OS率没有显著差异:结论:对于同步性不可切除远处转移的无症状mCRC,在贝伐单抗加FOLFIRI一线治疗后进行PTR可能会带来潜在的生存获益,尤其是IVA/IVB期患者与IVC期患者相比。此外,对于有不可切除转移灶的 mCRC 患者,对原发肿瘤进行 RT 治疗并不会带来额外的 OS 益处。要进一步阐明PTR在这种情况下的作用,必须进行样本量更大的前瞻性随机试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
3.60%
发文量
206
审稿时长
3-8 weeks
期刊介绍: The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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