PDF(Pubmed)
Abstract：
Patients who undergo primary tumor resection (PTR) reportedly have significantly higher overall survival (OS) than those who do not undergo this procedure. However, this result is only evident in past retrospective studies, and clinical trial results did not show the same trend. Thus, it remains unclear whether primary tumor resection effectively increases survival in patients with metastatic colorectal cancer (mCRC) across different study designs. We compared the OS of patients with asymptomatic unresectable mCRC who underwent PTR with that of those who did not. This retrospective cohort study was designed to be a target trial emulation of a randomized controlled trial (RCT) that would have compared the effectiveness of PTR versus non-PTR in patients with asymptomatic unresectable mCRC from 2009 to 2017. A systematic review and meta-analysis were conducted to compare the efficacy of PTR and non-PTR in patients with mCRC, and corresponding results were compared. This cohort included 1,132 patients for a per-protocol analysis. The PTR group had non-significantly longer survival (adjusted hazard ratio: 0.70, 95% confidence interval: 0.62-1.01) than the non-PTR group in our cohort. A meta-analysis including five RCTs (1,016 patients) and our cohort found that the PTR group did not have a significantly lower mortality rate than the non-PTR group. The results of this cohort study and previous RCTs suggest that PTR is not associated with improved survival compared to systemic chemotherapy combined with targeted therapy among asymptomatic unresectable mCRC patients. Therefore, routine PTR is not recommended in these patients.
摘要：
据报道，接受原发性肿瘤切除术（PTR）的患者的总生存率（OS）明显高于未接受该手术的患者。然而,这一结果仅在过去的回顾性研究中显而易见，和临床试验结果没有显示相同的趋势。因此，目前尚不清楚,在不同的研究设计中,原发性肿瘤切除术是否能有效提高转移性结直肠癌(mCRC)患者的生存率.我们比较了接受PTR的无症状不可切除mCRC患者与未接受PTR的患者的OS。这项回顾性队列研究旨在作为一项随机对照试验（RCT）的目标试验模拟，该试验将比较2009年至2017年无症状不可切除的mCRC患者中PTR与非PTR的有效性。进行了系统评价和荟萃分析，以比较PTR和非PTR在mCRC患者中的疗效。并对相应的结果进行了比较。该队列包括1,132名患者进行符合方案分析。在我们的队列中，PTR组比非PTR组具有非显著更长的生存期（调整后的风险比：0.70，95％置信区间：0.62-1.01）。包括5个RCTs（1,016例）和我们的队列的荟萃分析发现，PTR组的死亡率并未低于非PTR组。这项队列研究和以前的RCT结果表明，在无症状的不可切除的mCRC患者中，与全身化疗联合靶向治疗相比，PTR与改善生存率无关。因此,这些患者不推荐常规PTR.
