Aim: The complex medical care of synchronous metastatic colorectal (smCRC) patients requires prudent multidisciplinary planning and treatments due to various challenges caused by the primary tumor and its metastases. The role of primary tumor resection (PTR) is currently uncertain; strong arguments exist for and against it. We aimed to define its effect and find its best place in our therapeutic methodology. Method: We performed retrospective data analysis to investigate the clinical course of 449 smCRC patients, considering treatment modalities and the location of the primary tumor and comparing the clinical results of the patients with or without PTR between 1 January 2013 and 31 December 2018 at the Institute of Oncotherapy of the University of Pécs. Results: A total of 63.5% of the 449 smCRC patients had PTR. Comparing their data to those whose primary tumor remained intact (IPT), we observed significant differences in median progression-free survival with first-line chemotherapy (mPFS1) (301 vs. 259 days;p< 0.0001; 1 y PFS 39.2% vs. 26.6%; OR 0.56 (95% CI 0.36–0.87)) and median overall survival (mOS) (760 vs. 495 days;p< 0.0001; 2 y OS 52.4 vs. 26.9%; OR 0.33 (95% CI 0.33–0.53)), respectively. However, in the PTR group, the average ECOG performance status was significantly better (0.98 vs. 1.1;p= 0.0456), and the use of molecularly targeted agents (MTA) (45.3 vs. 28.7%;p= 0.0005) and rate of metastasis ablation (MA) (21.8 vs. 1.2%;p< 0.0001) were also higher, which might explain the difference partially. Excluding the patients receiving MTA and MA from the comparison, the effect of PTR remained evident, as the mOS differences in the reduced PTR subgroup compared to the reduced IPT subgroup were still strongly significant (675 vs. 459 days;p= 0.0009; 2 y OS 45.9 vs. 24.1%; OR 0.37 (95% CI 0.18–0.79). Further subgroup analysis revealed that the site of the primary tumor also had a major impact on the outcome considering only the IPT patients; shorter mOS was observed in the extrapelvic IPT subgroup in contrast with the intrapelvic IPT group (422 vs. 584 days;p= 0.0026; 2 y OS 18.2 vs. 35.9%; OR 0.39 (95% CI 0.18–0.89)). Finally, as a remarkable finding, it should be emphasized that there were no differences in OS between the smCRC PTR subgroup and metachronous mCRC patients (mOS 760 vs. 710 days,p= 0.7504, 2 y OS OR 0.85 (95% CI 0.58–1.26)). Conclusions: The role of PTR in smCRC is still not professionally justified. Our survey found that most patients had benefited from PTR. Nevertheless, further prospective trials are needed to clarify the optimal treatment sequence of smCRC patients and understand this cancer disease’s inherent biology.
目的：同步转移性结直肠癌（smCRC）患者的复杂医疗护理因原发肿瘤及其转移灶带来的多种挑战，需要审慎的多学科规划与治疗。目前，原发肿瘤切除术（PTR）的作用尚不明确，支持与反对的观点均存在有力论据。本研究旨在明确PTR的效果，并探索其在治疗策略中的最佳定位。 方法：我们对佩奇大学肿瘤治疗研究所2013年1月1日至2018年12月31日期间收治的449例smCRC患者进行了回顾性数据分析，考察其临床病程、治疗方式及原发肿瘤部位，并比较了接受PTR与未接受PTR（IPT）患者的临床结局。 结果：在449例smCRC患者中，63.5%接受了PTR。与原发性肿瘤未切除（IPT）的患者相比，PTR组患者在一线化疗的中位无进展生存期（mPFS1）（301天 vs. 259天；p < 0.0001；1年PFS 39.2% vs. 26.6%；OR 0.56（95% CI 0.36–0.87））和中位总生存期（mOS）（760天 vs. 495天；p < 0.0001；2年OS 52.4% vs. 26.9%；OR 0.33（95% CI 0.33–0.53））方面均显示出显著差异。然而，PTR组的平均ECOG体能状态评分显著更优（0.98 vs. 1.1；p = 0.0456），分子靶向药物（MTA）的使用率（45.3% vs. 28.7%；p = 0.0005）和转移灶消融（MA）率（21.8% vs. 1.2%；p < 0.0001）也更高，这可能部分解释了生存差异。在排除接受MTA和MA治疗的患者后进行比较，PTR的效应依然明显，缩减后的PTR亚组与缩减后的IPT亚组相比，mOS差异仍然高度显著（675天 vs. 459天；p = 0.0009；2年OS 45.9% vs. 24.1%；OR 0.37（95% CI 0.18–0.79））。进一步的亚组分析显示，仅考虑IPT患者时，原发肿瘤部位对结局也有重要影响：盆腔外IPT亚组与盆腔内IPT亚组相比，mOS更短（422天 vs. 584天；p = 0.0026；2年OS 18.2% vs. 35.9%；OR 0.39（95% CI 0.18–0.89））。最后，作为一个值得注意的发现，应强调smCRC PTR亚组与异时性mCRC患者之间的总生存期无差异（mOS 760天 vs. 710天，p = 0.7504，2年OS OR 0.85（95% CI 0.58–1.26））。 结论：PTR在smCRC中的作用尚未在专业上得到充分论证。我们的调查发现，大多数患者从PTR中获益。然而，仍需进一步的前瞻性试验来明确smCRC患者的最佳治疗顺序，并深入理解该癌症疾病的内在生物学特性。
肿瘤(癌症)患者之家