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中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (01) : 34 -41. doi: 10.3877/cma.j.issn.2095-3224.2023.01.005

论著

年龄对转移性结直肠癌不同治疗方法的影响及预后研究
张学东1, 白峻阁2,(), 刘正2, 吴殿文1,()   
  1. 1. 102100 北京市延庆区医院(北京大学第三医院延庆医院)普外科
    2. 100021 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
  • 收稿日期:2022-11-08 出版日期:2023-02-25
  • 通信作者: 白峻阁, 吴殿文

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

Xuedong Zhang1, Junge Bai2,(), Zheng Liu2, Dianwen Wu1,()   

  1. 1. Department of General Surgery, Beijing Yanqing District Hospital (Peking University Third Hospital Yanqing Hospital), Beijing 102100, China
    2. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2022-11-08 Published:2023-02-25
  • Corresponding author: Junge Bai, Dianwen Wu
引用本文:

张学东, 白峻阁, 刘正, 吴殿文. 年龄对转移性结直肠癌不同治疗方法的影响及预后研究[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(01): 34-41.

Xuedong Zhang, Junge Bai, Zheng Liu, Dianwen Wu. Study on the correlation between age and metastatic colorectal cancer treatment strategies and prognosis[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(01): 34-41.

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。

Objective

To explore the correlation between age and treatment strategies and prognosis of metastatic colorectal cancer.

Methods

A 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.

Results

The 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.

Conclusion

A 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.

表1 患者在不同年龄分段中的特征
特征 年龄分组(例,%) 检验值 P
年轻组(n=7 936) 中年组(n=24 108) 老年组(n=5 079)
性别 1.861E2 <0.0001
4 252(53.6) 13 740(57.0) 2 372(46.7)
3 684(46.4) 10 368(43.0) 2 707(53.3)
种族 1.464E2 <0.0001
白人 6 239(78.6) 19 753(81.9) 4 405(86.7)
黑人 1 104(13.9) 2 954(12.3) 421(8.3)
其他 593(7.5) 1 401(5.8) 253(5.0)
医保状况 6.030 E3 <0.0001
个人 5 729(72.2) 11 461(47.5) 471(9.3)
政府 1 591(20.1) 10 960(45.5) 4 527(89.1)
没有医保 462(5.8) 1 280(5.3) 30(0.6)
未知 154(1.9) 407(1.7) 51(1.0)
人口分布 1.030 E2 <0.0001
大城市 6 234(78.6) 17 842(74.0) 3 744(73.7)
城市 1 225(15.4) 4 650(19.3) 1 004(19.8)
乡村 143(1.8) 709(2.9) 143(19.8)
未知 334(4.2) 907(3.8) 188(3.7)
距离(英里) 2.420 E2 <0.0001
≤12.5 2 943(37.1) 9 736(40.4) 2 528(49.8)
12.5~50 3 090(38.9) 9 169(38.0) 1 713(33.7)
>50 1 734(21.9) 4 727(19.6) 735(14.5)
未知 169(2.1) 476(2.0) 103(2.0)
诊断年份 50.501 <0.0001
2004~2005 1 111(14.0) 3 321(13.8) 785(15.4)
2006~2007 1 208(15.2) 3 782(15.7) 861(17.0)
2008~2009 1 428(18.0) 4 244(17.6) 990(19.5)
2010~2011 1 490(18.8) 4 583(19.0) 945(18.6)
2012~2013 1 756(22.1) 5 272(21.9) 986(19.4)
2014 943(11.9) 2 906(12.0) 512(10.0)
Charlson-Deyo共病指数 8.249E2 <0.0001
0 7 226(91.1) 19 183(79.6) 3 685(72.6)
1 584(7.4) 3 897(16.2) 1 044(20.5)
2 76(1.0) 700(2.9) 265(5.2)
3 50(0.6) 328(1.3) 85(1.7)
医院类别 3.190E3 <0.0001
社区医院 361(4.6) 1744(7.2) 435(8.6)
综合社区肿瘤医院 1 699(21.4) 8 659(35.9) 2 210(43.5)
学术或研究型 3 200(40.3) 11 370(47.2) 1 967(38.7)
其他 2 676(33.7) 2 335(9.7) 467(9.2)
肿瘤位置 7.311E2 <0.0001
近端结肠 1 812(24.4) 7 708(34.4) 2 253(48.2)
远端结肠 2 511(33.9) 6 398(28.5) 1 056(22.6)
直乙交界或直肠 3 095(41.7) 8 311(37.1) 1 369(29.3)
未知 518(6.5) 1 691(7.0) 401(7.9)
分化程度 41.136 <0.0001
高分化 310(3.9) 993(4.1) 218(4.3)
中分化 4 361(55.0) 13 004(53.9) 2 557(50.3)
低分化 1 633(20.6) 4 794(19.9) 1 047(20.6)
未分化 1 632(20.7) 5 317(22.1) 1 257(24.8)
淋巴管侵犯 62.813 <0.0001
977(12.3) 2 941(12.2) 497(9.8)
1 344(16.9) 3 641(15.1) 685(13.5)
未知 5 615(70.8) 17 526(72.7) 3 897(76.7)
神经侵犯 1.047E2 <0.0001
1 683(21.2) 5 012(20.8) 962(18.9)
863(10.9) 2 083(8.6) 320(6.3)
未知 5 390(67.9) 17 013(70.6) 3 797(74.8)
诊断距离治疗开始的时间(天) 4.720E2 <0.0001
≤30 5 505(69.37) 14 822(61.5) 2 783(54.8)
31~60 1 410(17.8) 5 227(21.7) 1 074(21.2)
>60 449(5.7) 1 865(7.7) 403(7.9)
未知 572(7.2) 2 194(9.1) 819(16.1)
原发灶切除 95.127 <0.0001
2 733(34.4) 9 255(38.4) 2 178(42.9)
5 203(65.6) 14 853(61.6) 2 901(57.1)
转移灶切除 3.529E2 <0.0001
5 240(66.0) 17 411(72.2) 4 122(81.2)
2 696(34.0) 6 697(27.8) 957(18.8)
单药化疗 4.244 E2 <0.0001
7 372(92.9) 21 924(90.9) 4 188(82.5)
564(7.1) 2 184(9.1) 891(17.5)
多药化疗 2.606 E3 <0.0001
1 456(18.4) 6 842(28.4) 3 017(59.4)
6 480(81.7) 17 266(71.6) 2 062(40.6)
治疗方法 2.513E3 <0.0001
手术联合化疗 4 907(61.8) 12 855(53.3) 1 761(34.7)
仅化疗 2 513(31.7) 7 841(32.5) 1 398(27.5)
仅原发灶切除 296(3.7) 1 998(8.3) 1 140(22.5)
220(2.8) 1 414(5.9) 780(15.3)
图1 不同年龄组治疗方式的变化趋势
图2 治疗方式和治疗顺序对不同年龄组生存的影响
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