IVB期结直肠癌患者原发灶切除的临床意义：基于SEER数据库的倾向得分匹配分析
| 作者: |
1鲁伟群,
1刘海鹰
1 广州医科大学附属肿瘤医院 胃肠肿瘤外科，广东 广州 510095 |
| 通讯: |
刘海鹰
Email: gzdlhy2007@163.com |
| DOI: | 10.3978/.2018.04.007 |
| 基金: | 广东省广州市科技计划资助项目（201400000001-4）。 |
摘要
目的：探讨IVB期结直肠癌患者行原发病灶切除对预后的影响。
方法：收集SEER数据库2010—2013年诊断为IVB期结直肠癌患者共6 934例，其中发病灶切除联合全身化疗患者2 824例（手术化疗组），单纯全身化疗患者4 110例（化疗组）。采用倾向得分匹配（PSM）方法均衡两组患者临床病理特征后，比较两组患者生存率的差异。
结果：PSM前，手术化疗组患者生存率明显优于化疗组（HR=1.540，95% CI=1.423~1.667，P<0.001），但两组临床病理特征（性别、年龄、原发灶部位、病理分化程度、T分期、N分期、转移情况、CEA水平）不均衡性明显（均P<0.001）。通过1:1 PSM匹配后，筛选出3 826例患者，两组各1 913例；两组患者临床病理特征差异明显缩小，其中性别、年龄、原发灶部位、N分期、转移情况、CEA水平分布特征相接近（均P>0.05）；手术化疗组患者生存率明显优于化疗组（HR=1.603，95% CI=1.439~1.787，P<0.001）。
结论：手术切除原发病灶可改善转移灶不能切除的结直肠癌患者预后，故推荐可耐受手术的IVB期结直肠癌患者采取手术切除原发病灶联合全身化疗的治疗策略。
关键词：
结直肠肿瘤；肿瘤转移；倾向性评分；预后
方法：收集SEER数据库2010—2013年诊断为IVB期结直肠癌患者共6 934例，其中发病灶切除联合全身化疗患者2 824例（手术化疗组），单纯全身化疗患者4 110例（化疗组）。采用倾向得分匹配（PSM）方法均衡两组患者临床病理特征后，比较两组患者生存率的差异。
结果：PSM前，手术化疗组患者生存率明显优于化疗组（HR=1.540，95% CI=1.423~1.667，P<0.001），但两组临床病理特征（性别、年龄、原发灶部位、病理分化程度、T分期、N分期、转移情况、CEA水平）不均衡性明显（均P<0.001）。通过1:1 PSM匹配后，筛选出3 826例患者，两组各1 913例；两组患者临床病理特征差异明显缩小，其中性别、年龄、原发灶部位、N分期、转移情况、CEA水平分布特征相接近（均P>0.05）；手术化疗组患者生存率明显优于化疗组（HR=1.603，95% CI=1.439~1.787，P<0.001）。
结论：手术切除原发病灶可改善转移灶不能切除的结直肠癌患者预后，故推荐可耐受手术的IVB期结直肠癌患者采取手术切除原发病灶联合全身化疗的治疗策略。
Clinical value of primary tumor resection in patients with stage IVB colorectal cancer: a propensity score matching analysis based on SEER database
CorrespondingAuthor:LIU Haiying Email: gzdlhy2007@163.com
Abstract
Objective: To investigate the influence of primary tumor resection on prognosis of patients with stage IVB colorectal cancer.
Methods: A total of 6 934 patients diagnosed as stage IVB colorectal cancer between 2010 and 2013 were collected from the SEER database. Of the patients, 2 824 cases underwent primary tumor resection combined with systemic chemotherapy (surgery-chemotherapy group) and 4 110 cases underwent systemic chemotherapy alone (chemotherapy group). The difference in survival rate between the two groups of patients was compared after the clinicopathologic characteristics of the two groups of patients were balanced by propensity score matching (PSM).
Results: Before PSM, the survival rate in surgery-chemotherapy group was significantly better than that in chemotherapy group (HR=1.540, 95% CI=1.423–1.667, P<0.001), but there were significant imbalances in clinicopathologic characteristics (age, gender, primary tumor site, degree of histological differentiation, T stage, N stage, metastases and CEA level) between the two groups of patients (all P<0.001). After 1:1 matching of PSM, 3 826 patients were selected with 1 913 cases in either group; the differences in clinicopathologic characteristics between the two groups of patients were markedly minimized, in which, the distributions of age, gender, primary tumor site, N stage, metastases and CEA level of the two groups were well balanced (all P>0.05); the survival rate in surgery-chemotherapy group was significantly better than that in chemotherapy group (HR=1.603, 95% CI= 1.439–1.787, P<0.001).
Conclusion: Surgical resection of the primary tumor can improve the prognosis of colorectal cancer patients with unresectable metastatic lesions. So, the treatment strategy of primary tumor resection combined with systemic chemotherapy is recommended for patients with stage IVB colorectal cancer and surgical tolerance.
Keywords：
Colorectal Neoplasms; Neoplasm Metastasis; Propensity Score; Prognosis
Methods: A total of 6 934 patients diagnosed as stage IVB colorectal cancer between 2010 and 2013 were collected from the SEER database. Of the patients, 2 824 cases underwent primary tumor resection combined with systemic chemotherapy (surgery-chemotherapy group) and 4 110 cases underwent systemic chemotherapy alone (chemotherapy group). The difference in survival rate between the two groups of patients was compared after the clinicopathologic characteristics of the two groups of patients were balanced by propensity score matching (PSM).
Results: Before PSM, the survival rate in surgery-chemotherapy group was significantly better than that in chemotherapy group (HR=1.540, 95% CI=1.423–1.667, P<0.001), but there were significant imbalances in clinicopathologic characteristics (age, gender, primary tumor site, degree of histological differentiation, T stage, N stage, metastases and CEA level) between the two groups of patients (all P<0.001). After 1:1 matching of PSM, 3 826 patients were selected with 1 913 cases in either group; the differences in clinicopathologic characteristics between the two groups of patients were markedly minimized, in which, the distributions of age, gender, primary tumor site, N stage, metastases and CEA level of the two groups were well balanced (all P>0.05); the survival rate in surgery-chemotherapy group was significantly better than that in chemotherapy group (HR=1.603, 95% CI= 1.439–1.787, P<0.001).
Conclusion: Surgical resection of the primary tumor can improve the prognosis of colorectal cancer patients with unresectable metastatic lesions. So, the treatment strategy of primary tumor resection combined with systemic chemotherapy is recommended for patients with stage IVB colorectal cancer and surgical tolerance.