Yo I S, Opelka F G, Bolton J S, Fuhrman G M
Department of Colon and Rectal Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Am Surg. 2001 Feb;67(2):143-8.
The purpose of this study was to evaluate the impact of adjuvant chemotherapy on survival after surgery for T3N0 colon cancer. All patients with node-negative (N0) colon cancer with tumor invasion beyond the muscularis propria (T3) treated with colectomy between 1982 and 1995 at a single institution were included. Patients were divided into two groups depending on postcolectomy treatment with or without adjuvant chemotherapy. Groups were evaluated to determine perioperative and pathologic variables that could potentially influence outcome and surveillance data to determine disease-free and overall survival. In 253 patients with T3N0 colon cancer 226 remained under observation and 27 were treated with adjuvant chemotherapy. The groups were similar (P = not significant) when compared for tumor location, size, differentiation, number of nodes harvested, and transfusion requirements. Four of the 27 patients who received chemotherapy developed a recurrence (14.8%), whereas 22 of the 226 observation patients developed a recurrence (9.7%). Disease-free survival for the chemotherapy group at 5 years was 84 per cent and for the observation group 87 per cent. Statistical analysis (Mantel-Cox) showed no significant difference between the groups on the basis of survival (P = 0.3743). We conclude that resection alone is a highly effective treatment for T3N0 colon cancer leaving limited opportunity for adjuvant chemotherapy to significantly impact survival. Adjuvant chemotherapy for T3N0 colon cancer patients should be limited to patients enrolled in clinical trials designed to identify subgroups of T3N0 colon cancer patients at a survival disadvantage or less toxic adjuvant chemotherapies.
本研究的目的是评估辅助化疗对T3N0期结肠癌手术后生存的影响。纳入了1982年至1995年在单一机构接受结肠切除术治疗的所有肿瘤侵犯超过固有肌层（T3）且淋巴结阴性（N0）的结肠癌患者。根据结肠切除术后是否接受辅助化疗将患者分为两组。评估各组以确定可能影响预后的围手术期和病理变量以及监测数据，以确定无病生存期和总生存期。在253例T3N0期结肠癌患者中，226例接受观察，27例接受辅助化疗。比较两组的肿瘤位置、大小、分化程度、清扫淋巴结数量和输血需求时，两组相似（P = 无显著性差异）。接受化疗的27例患者中有4例复发（14.8%），而226例观察患者中有22例复发（9.7%）。化疗组5年无病生存率为84%，观察组为87%。统计分析（Mantel-Cox检验）显示两组在生存率方面无显著差异（P = 0.3743）。我们得出结论，单纯手术切除是治疗T3N0期结肠癌的高效方法，辅助化疗显著影响生存的机会有限。T3N0期结肠癌患者的辅助化疗应仅限于参加旨在确定生存处于劣势的T3N0期结肠癌患者亚组或毒性较小的辅助化疗方案的临床试验的患者。
