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Background <p>The optimal local therapy for oligometastatic colorectal cancer (CRC) remains undefined, with radical surgical resection and stereotactic body radiotherapy (SBRT) serving as the primary modalities. High-quality comparative evidence is scarce. This study aimed to prospectively compare overall survival (OS), local tumor control (LTC), quality of life (QoL), adverse events, and healthcare resource utilization between these two treatments.</p> Methods <p>In this prospective, observational cohort study, 478 patients with 1–3 oligometastases from CRC were enrolled. Treatment assignment was determined by a multidisciplinary tumor board. Propensity score matching (PSM) was used to adjust for baseline imbalances, creating 152 well-balanced pairs (<i>n</i> = 304) for analysis. The primary endpoint was OS; secondary endpoints included LTC, QoL (EORTC QLQ-C30), adverse events (CTCAE v5.0), and resource utilization.</p> Results <p>After PSM, the surgery group demonstrated a superior median OS compared to the SBRT group (65.1 months vs. 53.4 months; HR 1.48, 95% CI 1.04–2.10, <i>p</i> = 0.030). However, 2- and 3-year LTC rates were comparable between surgery and SBRT (87.3% vs. 86.1% and 79.8% vs. 78.2%, <i>p</i> = 0.220). Surgery was associated with a significantly higher incidence of major adverse events (27.6% vs. 7.9%, <i>p</i> &lt; 0.001) and a greater initial decline in QoL. By 12 months, the surgery group reported superior scores in global health status and key functional domains (all <i>p</i> &lt; 0.05). Healthcare resource utilization was substantially higher for surgery, with longer hospital stays, higher readmission rates, and greater costs.</p> Conclusion <p>In oligometastatic CRC, surgical resection is associated with a significant overall survival advantage compared to SBRT, albeit with increased upfront morbidity, resource use, and initial QoL impairment. SBRT offers a favorable safety profile and minimal short-term disruption with comparable local control. The choice between modalities represents a critical trade-off, underscoring the need for personalized, patient-centric decision-making.</p>

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Surgery versus stereotactic body radiotherapy for oligometastatic colorectal cancer: a prospective cohort study with propensity score matching

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月22日

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  • Daohai Wang,
  • Zhili Zhao,
  • Weijie Zhao,
  • Guanglong Chen,
  • Wei Du,
  • Zhi Li,
  • Jian Zhang

摘要

Background

The optimal local therapy for oligometastatic colorectal cancer (CRC) remains undefined, with radical surgical resection and stereotactic body radiotherapy (SBRT) serving as the primary modalities. High-quality comparative evidence is scarce. This study aimed to prospectively compare overall survival (OS), local tumor control (LTC), quality of life (QoL), adverse events, and healthcare resource utilization between these two treatments.

Methods

In this prospective, observational cohort study, 478 patients with 1–3 oligometastases from CRC were enrolled. Treatment assignment was determined by a multidisciplinary tumor board. Propensity score matching (PSM) was used to adjust for baseline imbalances, creating 152 well-balanced pairs (n = 304) for analysis. The primary endpoint was OS; secondary endpoints included LTC, QoL (EORTC QLQ-C30), adverse events (CTCAE v5.0), and resource utilization.

Results

After PSM, the surgery group demonstrated a superior median OS compared to the SBRT group (65.1 months vs. 53.4 months; HR 1.48, 95% CI 1.04–2.10, p = 0.030). However, 2- and 3-year LTC rates were comparable between surgery and SBRT (87.3% vs. 86.1% and 79.8% vs. 78.2%, p = 0.220). Surgery was associated with a significantly higher incidence of major adverse events (27.6% vs. 7.9%, p < 0.001) and a greater initial decline in QoL. By 12 months, the surgery group reported superior scores in global health status and key functional domains (all p < 0.05). Healthcare resource utilization was substantially higher for surgery, with longer hospital stays, higher readmission rates, and greater costs.

Conclusion

In oligometastatic CRC, surgical resection is associated with a significant overall survival advantage compared to SBRT, albeit with increased upfront morbidity, resource use, and initial QoL impairment. SBRT offers a favorable safety profile and minimal short-term disruption with comparable local control. The choice between modalities represents a critical trade-off, underscoring the need for personalized, patient-centric decision-making.