姑息性原发肿瘤切除术对微小症状(无症状)结直肠癌和同步不可切除转移瘤患者总生存期的影响与仅化疗的影响:结果比较研究

Iuliia Alimova, S. Achkasov, Y. Shelygin, M. Alekseev, V. Kashnikov, M. Fedyanin, M. A. Danilov, E. G. Rybakov
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摘要

目的:评估原发肿瘤切除术(PTR)对无症状或症状轻微的结直肠癌(CRC)和同步不可切除转移灶患者治疗效果的影响。患者和方法:对症状轻微的CRC和同步不可切除转移灶患者的治疗效果进行回顾性评估(2016-2022年)。将PTR后接受化疗的患者与仅接受化疗的患者进行比较。生存率采用卡普兰-梅耶法确定,差异采用对数秩检验和Cox比例危险回归模型进行评估。结果:两组患者的 30 天死亡率(р = 1,00)和因首次治疗并发症而进行手术治疗的比例(р = 1,00)无明显差异。配对前,PTR 组和化疗组的中位生存期分别为 27.8 个月和 24 个月(р = 0.2)。PSM 后,PTR 组的 3 年总生存率为 42.1%,化疗组为 34%(р = 0,47)。中位生存期分别为 27.9 个月和 24.4 个月。PTR 组 IVB 期患者的三年总生存率明显高于化疗组(37.8% 对 4.8%;р = 0.02)。中位生存期分别为 36.1 个月和 17.2 个月。在多变量分析中,如果无法切除的转移灶在初始治疗后转变为可切除,则根治性切除术(R0)是生存期的唯一重要预后因素(p < 0,001):对于无症状或症状轻微、有同步不可切除转移灶的 CRC 患者,PTR 与可接受的术后发病率和死亡率相关,与作为一线治疗手段的化疗相比,PTR 可提高 IVB 期患者的总生存率。不过,还需要进行随机对照试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The impact of palliative primary tumor resection on overall survival in minimally symptomatic (asymptomatic) colorectal cancer and synchronous unresectable metastases vs chemotherapy only: a comparative study of outcomes
Aim: to evaluate the impact of primary tumor resection (PTR) on treatment outcomes in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.Patients and Methods: treatment outcomes of patients with minimally symptomatic CRC and synchronous unresectable metastases were retrospectively assessed (2016–2022). Patients with PTR followed by chemotherapy were compared to patients receiving chemotherapy only. Survival was determined by the Kaplan-Meier method and differences were evaluated using the log-rank test and Cox proportional-hazards regression model. To reduce potential selection bias between two groups a propensity score matching (PSM) was performed.Results: no significant differences in 30-day mortality rate (р = 1,00) and the rate of surgical intervention due to complications of first treatment (р = 1,00) between the two groups. Before matching the median survivals were 27,8 and 24 months in the PTR and chemotherapy groups, respectively (р = 0,2). After PSM the overall survival rate at 3 years was 42,1% for the PTR group and 34% for the chemotherapy group (р = 0,47). The median survivals were 27,9 and 24,4 months, respectively. Three-year overall survival rate for patients with stage IVB was significantly higher in the PTR group than in the chemotherapy group (37,8% versus 4,8%; р = 0,02). The median survivals were 36,1 and 17,2 months, respectively. In multivariate analysis radical resection (R0) if unresectable metastases converted into resectable after initial treatment was the only significant prognostic factor for survival (p < 0,001).Conclusions: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases is associated with acceptable postoperative morbidity and mortality rates and may improve overall survival for patients with stage IVB comparing to chemotherapy as a treatment of first line. However, randomized controlled trials are needed.
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