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首页> 外文期刊>Journal of Cancer >Survival Benefit of Preoperative Versus Postoperative Radiotherapy in Metastatic Rectal Cancer Treated With Definitive Surgical Resection of Primary Tumor: A Population Based, Propensity Score-Matched Study
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Survival Benefit of Preoperative Versus Postoperative Radiotherapy in Metastatic Rectal Cancer Treated With Definitive Surgical Resection of Primary Tumor: A Population Based, Propensity Score-Matched Study

机译：术前与术后放疗对转移性直肠癌的原发性肿瘤明确性手术切除的生存获益：一项基于人群，倾向得分匹配的研究

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Preoperative chemoradiation followed by surgery has been recommended as a standard treatment for patients with stage II/III rectal cancer. However, the optimal sequencing of radiotherapy for metastatic rectal cancer remains unclear. Between 2004 and 2014, patients diagnosed with metastatic rectal cancer who underwent the resection of primary site and received radiotherapy were retrospectively selected using the Surveillance, Epidemiology, and End Results (SEER) database. The propensity score matching analyses were used to lessen the effects of confounding factors including age, sex, race, marital status, serum carcinoembryonic antigen level, histologic type, differentiation status, tumor size, T stage, N stage and resection of the distant lesions. The cancer-specific survival (CSS) were compared based on the sequencing of radiotherapy. Ultimately, 686 matched pairs were formed for comparison of preoperative versus postoperative radiotherapy. The 5-year CSS estimates were 33.4% (95% CI: 28.9%-37.9%) and 26.8% (95% CI: 22.7%-30.9%) for patients underwent preoperative radiotherapy followed by resection of primary lesion and postoperative radiotherapy after surgery, respectively. Patients underwent preoperative radiotherapy had better CSS as compared to patients received postoperative radiotherapy (p0.001 for log-rank test). Multivariate analysis demonstrated that preoperative radiotherapy group was associated with significantly decreased risk for cancer death (HR=0.820, 95% CI: 0.712-0.945, p=0.006). Preoperative radiotherapy was superior to postoperative radiotherapy in patients with metastatic rectal cancer. Therapeutic strategy for these patients should be further explored.
机译：对于II / III期直肠癌患者，建议术前放化疗后进行手术作为标准治疗方法。但是，对于转移性直肠癌的放疗最佳顺序仍不清楚。在2004年至2014年之间，使用监测，流行病学和最终结果（SEER）数据库回顾性选择了经诊断为转移性直肠癌的原发灶切除并接受放射治疗的患者。倾向得分匹配分析用于减轻混杂因素的影响，这些因素包括年龄，性别，种族，婚姻状况，血清癌胚抗原水平，组织学类型，分化状况，肿瘤大小，T期，N期和远处病变的切除。根据放疗的顺序比较了癌症特异性生存率（CSS）。最终，形成了686个匹配对，用于比较术前和术后放疗。术前放疗，术后原发灶切除和术后放疗的患者5年CSS估计值分别为33.4％（95％CI：28.9％-37.9％）和26.8％（95％CI：22.7％-30.9％） ， 分别。与接受术后放疗的患者相比，接受术前放疗的患者的CSS更好（对数秩检验p <0.001）。多因素分析表明，术前放疗组与癌症死亡风险显着降低相关（HR = 0.820，95％CI：0.712-0.945，P = 0.006）。对于转移性直肠癌患者，术前放疗优于术后放疗。这些患者的治疗策略应进一步探索。

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