年龄对转移性结直肠癌不同治疗方法的影响及预后研究

目的探讨年龄与转移性结直肠癌（mCRC）的治疗方式选择和预后的相关性。 方法我们从美国国家癌症数据库（NCDB）中选择了2004~2014年mCRC的患者,总数为43 977人,将患者分为三个年龄组：18~49岁、50~75岁和＞75岁。分别描述了每个治疗类别的患者百分比,包括仅原发性肿瘤切除术（PTR）、仅化疗和PTR加化疗。在调整人口统计学和临床因素后,计算并比较不同年龄组和治疗组的限制平均生存时间（RMST）。 结果18~49岁年龄组的大多数患者（61.8%）接受PTR联合化疗,50~75岁年龄组约有53.3%的患者接受PTR联合化疗,＞75岁年龄组大约有34.7%接受PTR联合化疗。在研究期间,所有年龄组的mCRC患者,PTR加化疗组呈下降趋势,而仅化疗组呈上升趋势。与其他治疗方法相比,PTR加化疗在所有年龄组中的生存率最高。除了18~49岁组的患者外,化疗与仅PTR相比具有更高的生存时间。在接受PTR加化疗治疗的患者中,与其他治疗相比,18~49和50~75岁组的围手术期化疗的患者可以获得更长的生存期,但＞75岁组的化疗与否和生存期无关。 结论尽管mCRC患者PTR加化疗呈下降趋势,但是其在所有年龄组中显示出最大的生存获益。不同的年龄组在接受特定的MDT治疗后的获益存在差异。

Study on the correlation between age and metastatic colorectal cancer treatment strategies and prognosis

ObjectiveTo explore the correlation between age and treatment strategies and prognosis of metastatic colorectal cancer. MethodsA total of 43 977 patients with mCRC were identified from the National Cancer Database (NCDB) spanning ten years (2004~2014). Patients were classified into three age groups: 18~49, 50~75, and >75 years old. Percentages of patients within each treatment category were described, including primary tumor resection (PTR) only, chemotherapy only, and PTR plus chemotherapy. After adjusting for demographic and clinical factors, restricted mean survival time (RMST) was calculated and compared between different age and treatment groups. ResultsThe majority (61.8%) of patients in the 18~49 age group received PTR plus chemotherapy; about half (53.3%) of the patients in the 50~75 age group and about one third (34.7%) in the >75 age group received PTR plus chemotherapy. There was a decreasing trend in the PTR plus chemotherapy group and an increasing trend in the chemotherapy only group for mCRC patients over the study time period in all age groups. PTR plus chemotherapy demonstrated the most favorable survival rate in all age groups compared to other treatments. Chemotherapy only was associated with significantly higher survival time compared to PTR, except for patients in the ages 18~49 group. Among patients who had PTR plus chemotherapy treatment, peri-operative chemotherapy was associated with the longest survival rate among patients in the ages 18~49 and 50~75 groups, but not in the >75 group, compared to other treatments. ConclusionA decreasing trend of PTR plus chemotherapy was observed among mCRC patients between 2004~2014, though it showed the most survival benefit in all age groups. The benefits of specific multimodality treatment vary by age group.