结直肠癌肝转移病人原发灶切除的临床意义及其预后影响因素分析——基于SEER数据库的倾向得分匹配分析  

Clinical significance and prognostic factors analysis of primary tumor resection in patients with liver metastasis of colorectal cancer——a propensity score matching analysis based on SEER database

作　　者：侯松林[1,2] 谢兴江 彭强 李利发 周何 周彤[1,2] HOU Songlin;XIE Xingjiang;PENG Qiang(Department of Gastrointestinal Surgery 2,Affiliated Hospital of North Sichuan Medical College,Sichuan,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院胃肠外二科,四川南充637000 [2]川北医学院肝胆胰肠研究所

出　　处：《临床外科杂志》2021年第6期543-548,共6页Journal of Clinical Surgery

基　　金：川北医学院博士科研启动基金资助项目(CBY20-QD03);南充市市校联合合作科研专项资金(18SXHZ0548)。

摘　　要：目的基于SEER数据库探讨不可切除转移灶的结直肠癌肝转移病人(CRLM)原发灶的切除对生存预后的影响并进一步分析其预后相关危险因素。方法获取SEER数据库中2010~2015年结直肠癌肝转移病人的临床及预后资料。根据标准筛选病例,最终获得高价值临床资料3920例,其中化疗联合原发灶切除组(联合组)3232例,单纯化疗组(化疗组)688例。采用倾向得分匹配(PSM)方法平衡两组病人的临床病理基线特征,比较两组病人的总体生存率(OS)和肿瘤特异性生存率(CSS)差异,通过COX比例风险回归模型对联合组中影响病人预后的危险因素进行分析。结果PSM前,联合组病人OS和CSS均明显高于化疗组(P<0.05),但两组中包括性别、肿瘤分级、肿瘤部位、肿瘤大小、种族、婚姻状态、T分期、N分期、CEA等临床病理特征具有显著的不均衡性(P<0.05)。通过1∶1 PSM匹配后,最终有效地筛选出1168例病人,联合组和化疗组分别584例,两组病人的临床病理特征差异明显缩小,其中性别、肿瘤分级、肿瘤大小、种族、婚姻状态、CEA等经过匹配后基线分布特征获得显著改善(P>0.05),而联合组病人的OS和CSS依旧显著高于化疗组(P<0.05)。采用COX等比例风险回归模型分析显示,年龄、肿瘤部位、肿瘤N分期、放疗、婚姻状态等是影响联合组病人预后的独立危险因素。结论对能够耐受手术的不可切除转移灶的CRLM病人应采取在全身化疗基础上联合原发灶切除的治疗策略。Objective Based on SEER database,to explore the effect of primary tumor resection on the prognosis of patients with liver metastases from colorectal cancer(CRLM)who are not feasible to remove metastases and to analysis the related factors of prognosis.Methods Collecting the clinical and prognostic data of patients with colorectal cancer liver metastases between 2010 and 2015 from the SEER database.According to the criteria,about 3,920 cases of high-value clinical data were finally obtained,including 3232 patients in the chemotherapy combined primary resection group(combination group)and 688 patients in the systemic chemotherapy alone group(chemotherapy group).Propensity score matching(PSM)method was used to balance the clinicopathological baseline characteristics of the two groups of patients,and the overall survival rate(OS)and cancer-specific survival rate(CSS)difference between the two groups of patients were compared.Analysis of risk factors for prognosis of patients in the combined group.Results Before matching through PSM,the OS and CSS in the combination group were significantly higher than those in the chemotherapy group(P<0.05),but the clinicopathological characteristics of the two groups showed significant imbalance,such as gender,tumor grade,tumor site,tumor size,race,marital status,T stage,N stage and CEA.After matching through PSM,1168 patients were finally effectively screened,including 584 patients in the combination group and chemotherapy group.The differences in clinical pathological characteristics of the two groups were significantly reduced,the baseline distribution characteristics were significantly improved(P>0.05),including gender,tumor grade,tumor size,race,marital status,and CEA.The OS and CSS of the combined group were still significantly higher than those of the chemotherapy group(P<0.05).After analyzing of the COX risk regression model,it was found that age,tumor location,tumor N stage,radiotherapy,and marital status were independent risk factors that affected the prognosis of patients

关 键 词：结直肠癌 肝转移 倾向得分匹配 预后 

分 类 号：R735.34[医药卫生—肿瘤]