转移灶不可切除结直肠癌切除原发灶对预后的影响

摘要

Objective To explore the influence of primary tumor resection with unresectable metastases on survival of colorectal cancer (CRC). Methods From January 2008 to December 2015, we retrospectively collected 96 advanced colorectal cancer patients with unresectable metastasis in our department. The patients were divided into the surgery group (primary tumor resection + postoperative chemotherapy) and chemotherapy group (receiving chemotherapy only). The difference of survival between the two groups was analyzed by Kaplan Meier Curve and the independent risk factors of prognosis were analyzed by COX regression model. Results The overall survival (OS) rates were 71.9％, 29.0％, and 24.8％ in the first year, third year, and fifth year respectively in the operation group; and 40.6％, 18.8％, and 0％ in the first year, third year, and fifth year separately in the chemotherapy group. The median survival was 18 months vs 4 months between the operation group and the chemotherapy group. Kaplan Meier analysis showed that the survival curve had statistic difference between these 2 groups (P = 0.002). COX regression model of multivariate analysis showed that primary tumors were resected in OR of 0.478, 95％ CI of 0.284-0.804 (P = 0.005). The original tumor in the rectum was the independent risk factor of OS in advanced colorectal cancer (CRC) with unresectable metastasis in OR of 0.427, 95％ CI of 0.226-0.810 (P = 0.009). Conclusion Primary tumor resection of colorectal cancer and normalized chemotherapy hadbetter prognosis than single chemotherapy. For colorectal cancer with unresectable metastasis, we should resect the original tumor initially and prognosis is better in primary tumor in the rectum than in the right hemicolon.%目的 分析转移灶不可切除的结直肠癌手术切除原发灶对总生存的影响,探讨转移灶不可切除的结直肠癌患者手术切除原发灶的价值.方法 回顾性分析2008年1月至2015年12月本院收治的96例转移灶不可切除的结直肠癌患者的临床和随访资料.Kaplan Meier生存曲线分析手术组(初始切除原发灶+术后规范化疗)与化疗组(单纯规范化疗)的生存时间差异,COX多因素回归模型分析影响两组预后的独立危险因素.结果 手术组总生存(Overall Survival,OS)率分别是1年71.9％、3年29％和5年24.8％,化疗组OS分别是1年40.6％、3年18.8％、5年0％,中位生存时间分别为手术组18个月和化疗组4个月.Kaplan Meier生存曲线显示手术组两组患者OS有明显差异(P=0.02).COX多因素回归模型分析显示原发灶切除(OR=0.478;95％CI=0.284-0.804;P=0.005)、原发灶位于直肠(OR=0.427;95％CI=0.226-0.810;P=0.009)是影响转移灶不可切除结直肠癌患者OS的独立预后因素.结论 初始切除原发灶+术后规范化疗比单纯规范化疗预后好,转移灶不可切除的结直肠癌患者应初始行原发灶切除.对于转移灶不可切除的结直肠癌患者,原发灶位于直肠比原发灶位于右半结肠预后好.