J Clin Oncol:已发生远处转移的IV期结直肠癌患者化疗前是否需要切除原发肿瘤?

2021-02-19 Nebula MedSci原创

结直肠癌(CRC)是主要的致死性癌症之一。

结直肠癌(CRC)是主要的致死性癌症之一。确诊时,大部分患者已经是IV期,肿瘤已不能通过手术切除,只能进行姑息性治疗。但对于同时存在无症状的原发肿瘤和不能切除的转移病灶的患者,初始治疗方案仍存在争议,主要围绕在化疗前切除原发肿瘤(PTR)是否能提高这类患者的生存率。

这项随机的III期研究调查了PTR联合化疗与单纯化疗相比,用于不能切除的IV期无症状CRC和仅限于肝、肺、远处淋巴结或腹膜的≤3处不能切除的转移性病灶患者的总存活率(OS)的优势。化疗方案为mFOLFOX6+贝伐单抗或CapeOX+贝伐单抗。主要终点是OS,通过意向治疗进行分析。

2012年6月-2019年9月,共有165名患者被随机分配到两组:单纯化疗 84名、PTR+化疗组 81名。2019年9月进行了首次中期分析:截止2019年6月5日,在160名患者中观察到了50%的预期事件(114/227),数据和安全监测委员会建议提前终止试验。

预后

中位随访了22.0个月,PTR+化疗组的中位OS为25.9个月(95%CI,19.9~31.5),单纯化疗组的中位OS为26.7个月(95%CI,21.9~32.5)(风险比 1.10;95%CI,0.76~1.59;单侧p=0.69)。PTR+化疗组有3例术后死亡病例。

综上,与单纯化疗相比,PTR联合化疗并不能提高患者的生存率,因此PTR不应再被认为是无症状原发肿瘤和不能切除转移同时存在的结直肠癌患者的标准治疗方案。

原始出处:

Kanemitsu Yukihide,Shitara Kohei,Mizusawa Junki et al. Primary Tumor Resection Plus Chemotherapy Versus Chemotherapy Alone for Colorectal Cancer Patients With Asymptomatic, Synchronous Unresectable Metastases (JCOG1007; iPACS): A Randomized Clinical Trial. J Clin Oncol, 2021, undefined: JCO2002447.

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    2021-03-14 minlingfeng
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1776492, encodeId=95f81e7649268, content=<a href='/topic/show?id=6f553e14927' target=_blank style='color:#2F92EE;'>#原发肿瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37149, encryptionId=6f553e14927, topicName=原发肿瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09b838947217, createdName=经常头晕, createdTime=Thu Apr 08 03:00:40 CST 2021, time=2021-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866014, encodeId=8e15186601446, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Mar 14 07:00:40 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423500, encodeId=cb361423500e4, content=<a href='/topic/show?id=badd9441868' target=_blank style='color:#2F92EE;'>#远处转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94418, encryptionId=badd9441868, topicName=远处转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c42b3793913, createdName=hanhaisha2009, createdTime=Sun Feb 21 12:00:40 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1453477, encodeId=8c4914534e731, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Sun Feb 21 12:00:40 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1038216, encodeId=8d791038216e3, content=谢谢梅斯分享这么多精彩信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=anti-cancer, createdTime=Sat Feb 20 00:00:40 CST 2021, time=2021-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925553, encodeId=62099255537c, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=712d5461304, createdName=ms2000002063028856, createdTime=Fri Feb 19 21:37:57 CST 2021, time=2021-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925549, encodeId=39d29255493e, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Fri Feb 19 21:14:22 CST 2021, time=2021-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925542, encodeId=9b17925542c1, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fdc65325659, createdName=148ba795m17暂无昵称, createdTime=Fri Feb 19 21:08:19 CST 2021, time=2021-02-19, status=1, ipAttribution=)]
    2021-02-20 anti-cancer

    谢谢梅斯分享这么多精彩信息

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1776492, encodeId=95f81e7649268, content=<a href='/topic/show?id=6f553e14927' target=_blank style='color:#2F92EE;'>#原发肿瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37149, encryptionId=6f553e14927, topicName=原发肿瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09b838947217, createdName=经常头晕, createdTime=Thu Apr 08 03:00:40 CST 2021, time=2021-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866014, encodeId=8e15186601446, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Mar 14 07:00:40 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423500, encodeId=cb361423500e4, content=<a href='/topic/show?id=badd9441868' target=_blank style='color:#2F92EE;'>#远处转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94418, encryptionId=badd9441868, topicName=远处转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c42b3793913, createdName=hanhaisha2009, createdTime=Sun Feb 21 12:00:40 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1453477, encodeId=8c4914534e731, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Sun Feb 21 12:00:40 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1038216, encodeId=8d791038216e3, content=谢谢梅斯分享这么多精彩信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=anti-cancer, createdTime=Sat Feb 20 00:00:40 CST 2021, time=2021-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925553, encodeId=62099255537c, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=712d5461304, createdName=ms2000002063028856, createdTime=Fri Feb 19 21:37:57 CST 2021, time=2021-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925549, encodeId=39d29255493e, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Fri Feb 19 21:14:22 CST 2021, time=2021-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925542, encodeId=9b17925542c1, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fdc65325659, createdName=148ba795m17暂无昵称, createdTime=Fri Feb 19 21:08:19 CST 2021, time=2021-02-19, status=1, ipAttribution=)]
    2021-02-19 ms2000002063028856

    学习学习

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1776492, encodeId=95f81e7649268, content=<a href='/topic/show?id=6f553e14927' target=_blank style='color:#2F92EE;'>#原发肿瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37149, encryptionId=6f553e14927, topicName=原发肿瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09b838947217, createdName=经常头晕, createdTime=Thu Apr 08 03:00:40 CST 2021, time=2021-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866014, encodeId=8e15186601446, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Mar 14 07:00:40 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423500, encodeId=cb361423500e4, content=<a href='/topic/show?id=badd9441868' target=_blank style='color:#2F92EE;'>#远处转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94418, encryptionId=badd9441868, topicName=远处转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c42b3793913, createdName=hanhaisha2009, createdTime=Sun Feb 21 12:00:40 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1453477, encodeId=8c4914534e731, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Sun Feb 21 12:00:40 CST 2021, time=2021-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1038216, encodeId=8d791038216e3, content=谢谢梅斯分享这么多精彩信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=anti-cancer, createdTime=Sat Feb 20 00:00:40 CST 2021, time=2021-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925553, encodeId=62099255537c, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=712d5461304, createdName=ms2000002063028856, createdTime=Fri Feb 19 21:37:57 CST 2021, time=2021-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925549, encodeId=39d29255493e, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Fri Feb 19 21:14:22 CST 2021, time=2021-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=925542, encodeId=9b17925542c1, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fdc65325659, createdName=148ba795m17暂无昵称, createdTime=Fri Feb 19 21:08:19 CST 2021, time=2021-02-19, status=1, ipAttribution=)]
    2021-02-19 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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    2021-02-19 148ba795m17暂无昵称

    学习了!

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