无症状转移性结直肠癌原发灶切除的优势人群探索

摘要/Abstract

摘要：

目的探索无症状转移性结直肠癌（mCRC）原发灶切除获益的人群。方法回顾性分析2014年1月至2019年1月长江大学附属第一医院收治的121例肝转移灶不可切除的无症状mCRC患者的临床病理资料。采用Kaplan-Meier法绘制生存曲线，并行log-rank检验。采用Cox回归模型分析患者的预后影响因素。结果121例mCRC患者中位总生存期（OS）为20个月，3年、5年OS率分别为34.71%、10.74%。原发灶切除与未切除患者的中位OS分别为21个月和18个月，差异无统计学意义（χ²=0.79，P=0.375）。65例接受靶向治疗的mCRC患者中，原发灶切除与未切除患者的中位OS分别为25个月和28个月，差异无统计学意义（χ²=1.65，P=0.199）。84例左半结肠、直肠mCRC患者中，原发灶切除与未切除患者的中位OS分别为24个月和18个月，差异有统计学意义（χ²=4.25，P=0.039）。37例右半结肠mCRC患者中，原发灶切除与未切除患者的中位OS分别为19个月和17个月，差异无统计学意义（χ²=0.18，P=0.675）。64例接受肝转移灶局部治疗的mCRC患者中，原发灶切除与未切除患者的中位OS分别为36个月和17个月，差异有统计学意义（χ²=12.60，P<0.001）。57例未接受肝转移灶局部治疗的mCRC患者中，原发灶切除与未切除患者的中位OS分别为15个月和17个月，差异无统计学意义（χ²=0.58，P=0.445）。单因素分析显示，原发灶部位（HR=0.51，95%CI为0.25~0.76，P=0.025）、分化程度（HR=1.46，95%CI为1.13~9.45，P=0.004）、肝转移灶最大直径（HR=1.86，95%CI为1.35~4.60，P=0.012）、血清癌胚抗原（HR=3.55，95%CI为2.55~8.45，P<0.001）、肝转移灶局部治疗（HR=0.35，95%CI为0.19~0.93，P<0.001）是肝转移灶不可切除的无症状mCRC患者OS的影响因素。多因素分析显示，原发灶部位为左半结肠、直肠（HR=0.43，95%CI为0.25~0.93，P=0.039）、接受肝转移灶局部治疗（HR=0.78，95%CI为0.27~0.86，P<0.001）是肝转移灶不可切除的无症状mCRC患者OS的独立影响因素。结论原发灶部位为左半结肠、直肠和接受肝转移灶局部治疗是肝转移灶不可切除的无症状mCRC接受原发灶切除获益的人群。

关键词:结直肠肿瘤,外科手术,肝转移,原发灶

Abstract:

ObjectiveTo explore the population who benefit from primary tumor resection （PTR） of asymptomatic metastatic colorectal cancer （mCRC）.MethodsThe clinicopathological data of 121 patients with asymptomatic mCRC with unresectable liver metastases treated in the First Affiliated Hospital of Yangtze University from January 2014 to January 2019 were retrospectively analyzed. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors.ResultsThe median overall survival （OS） of 121 mCRC patients was 20 months, and the 3- and 5-year survival rates were 34.71% and 10.74%. The median OS of PTR and non-PTR patients were 21 months and 18 months respectively, with no statistically significant difference （χ²=0.79,P=0.375）. In 65 mCRC patients received targeted therapy, the median OS of PTR and non-PTR patients were 25 months and 28 months respectively, with no statistically significant difference （χ²=1.65,P=0.199）. In 84 patients with mCRC of the left colon and rectum, the median OS of PTR and non-PTR patients were 24 months and 18 months respectively, with a statistically significant difference （χ²=4.25,P=0.039）. In 37 patients with mCRC of the right colon, the median OS of PTR and non-PTR patients were 19 months and 17 months respectively, with no statistically significant difference （χ²=0.18,P=0.675）. In 64 mCRC patients who received liver local treatment, the median OS of PTR and non-PTR patients were 36 months and 17 months respectively, with a statistically significant difference （χ²=12.60,P<0.001）. In 57 mCRC patients who did not receive liver local treatment, the median OS of PTR and non-PTR patients were 15 months and 17 months respectively, with no significant difference （χ²=0.58,P=0.445）. Univariate analysis showed that the location of the primary tumor （HR=0.51, 95%CI: 0.25-0.76,P=0.025）, the degree of differentiation （HR=1.46, 95%CI: 1.13-9.45,P=0.004）, the maximum diameter of the liver metastases （HR=1.86, 95%CI: 1.35-4.60,P=0.012）, the level of serum carcinoembryonic antigen （HR=3.55, 95%CI: 2.55-8.45,P<0.001）, local treatment of liver metastases （HR=0.35, 95%CI: 0.19-0.93,P<0.001） were influencing factors for OS of asymptomatic mCRC patients with unresectable liver metastases. Multivariate analysis showed that the primary sites of the left colon and rectum （HR=0.43, 95%CI: 0.25-0.93,P=0.039）, local treatment of liver metastases （HR=0.78, 95%CI: 0.27-0.86,P<0.001） were independent influencing factors for OS of asymptomatic mCRC patients with unresectable liver metastases.ConclusionAsymptomatic mCRC patients with unresectable liver metastases with primary sites of the left colon and rectum and local treatment of liver metastases can benefit from PTR.

Key words:Colorectal neoplasms,Surgical procedures, operative,Liver metastases,Primary tumor

曾海, 张为家, 王茜, 章凡, 李爽. 无症状转移性结直肠癌原发灶切除的优势人群探索[J]. 国际肿瘤学杂志, 2022, 49(12): 729-734.

Zeng Hai, Zhang Weijia, Wang Qian, Zhang Fan, Li Shuang. Exploration of the preponderant population for primary tumor resection of asymptomatic metastatic colorectal cancer[J]. Journal of International Oncology, 2022, 49(12): 729-734.

图/表9

表1

121例肝转移灶不可切除的无症状mCRC患者的一般临床资料"

一般临床特征	例数	百分比（%）
性别
男	79	65.30
女	42	34.70
年龄（岁）
≥60	71	58.70
<60	50	41.30
原发灶部位
左半结肠、直肠	84	69.40
右半结肠	37	30.60
原发灶T分期
T_1-2	18	14.88
T_3-4	103	85.12
N分期
N₀	58	47.93
N₊	63	52.07
分化程度
低分化	46	38.02
中-高分化	75	61.98
肝转移灶最大直径（cm）
≥5	54	44.62
<5	67	55.38
血清癌胚抗原（ng/ml）
≥200	31	25.62
<200	90	74.38
靶向治疗
是	65	53.70
否	56	46.30
肝转移灶局部治疗
是	64	52.90
否	57	47.10
原发灶切除与否
是	65	53.70
否	56	46.30

表1

图1

图2

图3

图4

图5

图6

表2

121例肝转移灶不可切除的无症状mCRC患者OS单因素分析"

因素	HR值	95%CI	P值
性别（男/女）	1.76	0.12~4.36	0.862
年龄（≥60岁/<60岁）	1.12	0.79~5.12	0.549
原发灶部位（左半结肠、直肠/右半结肠）	0.51	0.25~0.76	0.025
原发灶T分期（T_1-2/T_3-4）	0.74	0.96~8.56	0.845
N分期（N₀/N₊）	0.73	0.95~4.23	0.104
分化程度（低分化/中-高分化）	1.46	1.13~9.45	0.004
肝转移灶最大直径（≥5 cm/<5 cm）	1.86	1.35~4.60	0.012
血清癌胚抗原（≥200 ng/ml/<200 ng/ml）	3.55	2.55~8.45	<0.001
靶向治疗（是/否）	0.95	0.64~3.14	0.406
肝转移灶局部治疗（是/否）	0.35	0.19~0.93	<0.001
原发灶切除（是/否）	0.96	0.49~2.51	0.380

表2

因素	HR值	95%CI	P值
原发灶部位（左半结直肠/右半结肠）	0.43	0.25~0.93	0.039
分化程度（低分化/中-高风化）	1.72	0.94~2.53	0.732
肝转移灶最大直径（≥5 cm/<5 cm）	1.28	0.91~8.43	0.121
血清癌胚抗原（≥200 ng/ml/<200 ng/ml）	2.12	0.76~4.21	0.824
肝转移灶局部治疗（是/否）	0.78	0.27~0.86	<0.001

表3

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