恶性结直肠癌患者原位切除手术越少，存活率越高

  一篇刊登在国际杂志JAMA Surgery上的研究报告中，来自美国德州大学MD安德森癌症中心的研究人员表示，自从1988年以来，每年IV级恶性结直肠癌原发性肿瘤切除率已开始下降，在2001年针对疾病非手术方法的管理趋势中已将新型的化疗方法和生物性疗法作为治疗结直肠癌的可用疗法。

  结直肠癌是美国第三大常见癌症，而且也是引发美国个体死亡的第三大主要疾病；大约有20%的病人会被诊断为晚期IV级结直肠癌，而且其5年平均相对生存率只有12.5%。

  研究者Chung-Yuan Hu表示，文章中我们检测了IV级结直肠癌患者的原发性肿瘤切除模式，并且分析了患者的生存率；随后研究人员分析了来自美国国家癌症研究所针对结直肠癌的监测、流行病学等数据，研究者在1988年至2010年期间，对64157名诊断为IV级结肠癌或直肠癌患者的数据进行了分析，这些患者中包括进行原发性肿瘤切除和未切除的个体。

  研究结果显示，67.4%的病人进行了原发性肿瘤切除术，而每年原发性肿瘤的切除率从1988年的74.55下降到了2010年的57.4%，其中在1998年至2001年及2001年至2010年间原发性肿瘤的切除率发生了明显的改变。

  研究者表示，接受原发性肿瘤切除的病人更趋向于50岁以下的女性已婚个体，而这些患者都具有较高的肿瘤级别，而且还患有结肠癌；研究结果显示，IV 结直肠癌患者的中位生存率从1988年的8.6%增加到了2009年的17.8%。同时研究人员也指出了本研究的局限性，即原发性肿瘤切除率的下降可能是由患者采取了更有效的治疗方法所导致。

  最后研究者总结道，尽管当前存在很多种化疗方法，但很多IV级结直肠癌患者仍会继续选择进行原发性肿瘤切除术来治疗；但在这些患者中原发性肿瘤切术的过度使用或许会影响患者的生存率，严重影响其生活质量。（转化医学网360zhyx.com）

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转化医学网推荐的原文摘要：

Time Trend Analysis of Primary Tumor Resection for Stage IV Colorectal Cancer: Less Surgery, Improved Survival
JAMA Surg doi:10.1001/jamasurg.2014.2253
Chung-Yuan Hu, MPH, PhD1; Christina E. Bailey, MD, MS1; Y. Nancy You, MD, MHSc1; John M. Skibber, MD1; Miguel A. Rodriguez-Bigas, MD1; Barry W. Feig, MD1; George J. Chang, MD, MS1
Importance With the advent of effective modern chemotherapeutic and biologic agents, primary tumor resection for patients with stage IV colorectal cancer (CRC) may not be routinely necessary.
Objective To evaluate the secular patterns of primary tumor resection use in stage IV CRC in the United States.
Design, Setting, and Participants A retrospective cohort study using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results CRC registry. Demographic and clinical factors were compared for 64 157 patients diagnosed with stage IV colon or rectal cancer from January 1, 1988, through December 31, 2010, who had undergone primary tumor resection and those who had not. Rates of primary tumor resection and median relative survival were calculated for each year. Joinpoint regression analysis was used to determine when a significant change in trend in the primary tumor resection rate had occurred. Logistic regression analysis was used to assess factors associated with primary tumor resection.
Main Outcomes and Measures Difference in primary tumor resection rates over time.
Results Of the 64 157 patients with stage IV CRC, 43 273 (67.4%) had undergone primary tumor resection. The annual rate of primary tumor resection decreased from 74.5% in 1988 to 57.4% in 2010 (P < .001), and a significant annual percentage change occurred between 1998-2001 and 2001-2010 (–0.41% vs –2.39%; P < .001). Factors associated with primary tumor resection were age younger than 50 years, female sex, being married, higher tumor grade, and presence of colon tumors. Median relative survival rate improved from 8.6% in 1988 to 17.8% in 2009 (P < .001); the annual percentage change was 2.18% in 1988-2001 and 5.43% in 1996-2009 (P < .001).
Conclusions and Relevance The majority of patients with stage IV CRC had undergone primary tumor resection but, beginning in 2001, a trend toward fewer primary tumor resections was seen. Despite the decreasing primary tumor resection rate, patient survival rates improved. However, primary tumor resection may still be overused, and current treatment practices lag behind evidence-based treatment guidelines.