The Clinical Features And Treatment Evaluation Of Stage â…£ Patients With Unresectable Metastatic Colorectal Cancer

BackgroudIn recent years, the incidence and mortality of colorectal cancer has continued to rise, nearly thirty percent of patients are found having distant metastasis at the time of initial diagnosis. Considering the size, number and other factors of distant metastases, some patients are not resectable. We define these patients as stage IV patients with unresectable metastatic colorectal cancer. According to NCCN clinical practice guidelines recommend, it should be discussed and decided after a Multidisciplinary discussion. The individual with unresectable metastatic colorectal cancer differs, so the choice of treatment is also diverse:chemotherapy, surgery, combination therapy, radiofrequency ablation, Chinese medicine treatment can be used in clinical practice.ObjectiveThe aim of the study was to analysis the characteristic and survival time of patients with unresectable metastatic colorectal cancer, in order to select the best treatment for these patients and feedback to guide the clinical work. Materials and MethodsA series of 99 patients with unresectable metastatic colorectal cancer who received treatment between May 2002 to May 2015 in the Department of anus & intestine surgery of Sir Run Run Shaw hospital was involved in this retrospective study. The following data of the patients were collected:age, gender, primary tumor, the number of metastases organs, CEA levels before treatment, colonoscopy traversable or not before treatment, treatment options and the survival time.ResultsUnivariate analysis showed:age, sex, primary tumor site, the number of metastasis organs do litter affect on the survival time of the patients with unresectable metastatic colorectal cancer (p> 0.05). CEA levels before treatment, colonoscopy traversable or not before treatment are related to the primary tumor survival time, but there was no statistically significant difference (p= 0.186, p= 0.116). The choice of treatment has significantly different (p= 0.007) on survival time, where the combination therapy had a greater benefit for patients compared with surgery alone or chemotherapy alone. Basic on the result of the univariate analysis, multivariate analysis found:the choice of treatment have significant effect on the survival time (p= 0.038). Colonoscopy traversable or not affect primary tumor survival time, but did not have statistically difference (p= 0.059). No statistically significant difference (p= 0.302) with the factor of CEA levels before treatment. Stratified analysis showed:the survival time to the colonoscopy nontraversable stage IV patients after combination therapy was longer than other treatments.the survival time to the colonoscopy traversable stage IV patients showed no significantly difference between different treatments.ConclusionChoice of treatment affected the survival time for patients with unreseetable metastatic colorectal cancer.In general, the combination therapy had a greater benefit for patients compared with surgery alone or chemotherapy alone.For the colonoscopy nontraversable stage IV patients, the best choice for them is combination therapy while for the colonoscopy traversable stage IV patients,the choice of treatment has no significant difference in survival time.