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《工程(英文)》 >> 2021年 第7卷 第4期 doi: 10.1016/j.eng.2020.10.017

转移性结直肠癌治疗模式随时间的变化趋势以及其与患者生存期的关系——一项基于智能大数据平台的回顾性队列研究

a Department of Medical Oncology, State Key Laboratory of Oncology in South China & Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer
Center, Guangzhou 510060, China
b Artificial Intelligence Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
c Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou 510060, China
d Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
e Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
f Department of Minimally Invasive Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China

# These authors contributed equally to this study.

收稿日期: 2020-08-02 修回日期: 2020-09-01 录用日期: 2020-10-09 发布日期: 2021-01-05

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摘要

目前,尤其是在国内,仍缺乏大规模的、高质量的转移性结直肠癌(metastatic colorectal cancer, mCRC)真实世界数据。目前尚不清楚在真实世界临床实践中提高mCRC患者的治疗质量能否为我国mCRC患者带来生存获益。基于智能大数据平台,我们建立了一个大样本的mCRC回顾性队列。我们分析了全身性治疗及局部治疗手段[包括肝转移、肺转移或肝外和(或)肺外转移灶的手术切除、射频消融以及立体定向放疗]随年份的变化趋势,以及分析了这些改变是否可改善患者的总生存期(overall survival, OS)。在2012年7月至2018年12月期间,共纳入3403名符合条件的mCRC患者。本研究队列的中位OS为42.8个月[95% 置信区间(confidence interval, CI),40.7~46.6];其中,仅接受了全身性治疗的患者的中位OS为25.6个月(95% CI, 24.7 ~ 26.9),而接受了局部治疗的患者的中位OS未达到(95% CI, 78.6个月至未达到)。接受局部治疗的患者比例持续升高,从2012-2014年的37.9%逐步上升到2017-2018年的46.9%。西妥昔单抗/贝伐珠单抗的使用率从2017年开始明显增加(在2012–2014年、2015–2016年、2017–2018年分别为39.9%、 43.2%及60.3%)。相比2012–2014年的患者,2015–2016年的患者的OS显著延长[风险比(hazard ratio, HR)= 0.87 (95% CI, 0.78 – 0.99); P = 0.034],而仅接受全身性治疗的患者则无显著差异[HR = 0.99 (95% CI, 0.86 – 1.14); P = 0.889];相比2012–2014年的患者,2015–2016年的患者的OS显著延长[HR = 0.75 (95% CI, 0.70 – 0.81); P < 0.001],并且该优势在仅接受全身性治疗的患者中依然存在[HR = 0.83 (95% CI, 0.77 – 0.91); P < 0.001]。综上,本队列研究表明mCRC全身性治疗及局部治疗的使用率的提高可以为患者带来生存获益。

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