原发灶手术对转移性结肠腺癌患者生存期的影响：一项人群队列回顾性研究
| 作者: |
1乔云锋,
1张芮,
1韩江龙,
1黄柯洁,
1王诗杰,
1付振明
1 武汉大学人民医院肿瘤中心，武汉 430060 |
| 通讯: |
付振明
Email: Davidfuzming@whu.edu.cn |
| DOI: | 10.3978/j.issn.2095-6959.2020.06.011 |
| 基金: | 国家自然科学基金(81472971，81773555)。 |
摘要
目的：评估手术对转移性结肠腺癌患者生存期的影响。方法：从美国SEER数据库中收集从2010年1月至2014年12月的转移性结肠腺癌患者。为确保手术组和对照组的基线特征平衡，采用1:1倾向性评分匹配(propensity score matching，PSM)来平衡两组间不同混杂因素的干扰。并采用Kaplan-Meier和Cox’s分析数据评估总体生存率(overall survival，OS)和癌症特异性生存率(cancer-specific survival，CSS)和相应的95%置信区间(confidence intervals，CIs)。结果：在PSM前后，手术组OS和CSS显著提高(P<0.001)。转移性结肠腺癌在PSM后，手术组OS[25个月 vs 14个月；危险比(hazard ratio，HR)=0.43，95%CI：0.38~0.48]和CSS(30个月 vs 17个月；HR=0.42，95%CI：0.37~0.48)显著提高。PSM后手术组单个部位转移的患者OS提高超过1年(P<0.001)，广泛转移(≥2个部位)患者的OS和CSS也均有提高(P<0.05)。结论：在化学药物治疗基础上，手术提高了转移期结肠腺癌患者的OS。
关键词：
手术；结肠腺癌；转移；SEER
Effect of primary tumor resection on survival in patients with metastatic colon adenocarcinoma: A cohort retrospective study
CorrespondingAuthor: FU Zhenming Email: Davidfuzming@whu.edu.cn
DOI: 10.3978/j.issn.2095-6959.2020.06.011
Foundation: This work was supported by the National Natural Science Foundation of China (81472971, 81773555).
Abstract
Objective: To evaluate whether surgery has an effect on the survival of metastatic colon adenocarcinoma patients. Methods: We analyzed metastatic colon adenocarcinoma patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) registry from January 2010 to December 2014. Propensity score (PS) analysis with 1:1 matching and the nearest neighbor matching method was performed to ensure well-balanced characteristics of comparison groups. Data was analyzed by Kaplan-Meier and Cox’s proportional hazards regression models to evaluate the overall survival (OS) and cancer-specific survival (CSS) with corresponding 95% confidence intervals (95%CIs). Results: In general, surgery remarkably improved OS and CSS both before and after PS matching (PSM) (P<0.001), with a significantly improved OS [25 months vs 14 months; hazard ratio (HR)=0.43, 95% CI: 0.38–0.48] and CSS (30 months vs 17 months; HR=0.42, 95% CI: 0.37–0.48) of 13 months after PSM in all stage M1 colon adenocarcinoma patients. After PSM, surgery was found to be associated with remarkably >1 year improved survival for stage M1 patients with only one metastasis (P<0.001), and even for stage M1 patients with extensive metastasis (≥2 metastatic sites) (P<0.05). Conclusion: The large SEER results supported surgery might improve the survival of patients with metastatic colon adenocarcinoma on the basis of chemotherapy.
Keywords：
surgery; colon adenocarcinoma; metastasis; SEER