Phelip J M, Molinié F, Delafosse P, Launoy G, Trétarre B, Bara S, Buémi A, Velten M, Danzon A, Ganry O, Bouvier A M, Grosclaude P, Faivre J
Registre Bourguignon des Cancers Digestifs, Inserm U866, Université de Bourgogne, CHU de Dijon, BP 87900, 21079 Dijon cedex, France.
Gastroenterol Clin Biol. 2010 Feb;34(2):144-9. doi: 10.1016/j.gcb.2009.08.012. Epub 2010 Jan 15.
Although clinical trials have demonstrated that adjuvant chemotherapy improves survival for stage-III colon cancer, the benefits remain controversial for stage-II lesions. The objective of the present study was to determine the extent to which adjuvant chemotherapy is used for patients with stage-II and -III colon cancers.
The study population comprised 1074 patients with stage-II and -III colon cancers diagnosed in 2000 in 12 French administrative districts and recorded in population-based cancer registries. Data were collected using a standardized procedure.
Overall, 20.4% of patients with stage II and 61.9% with stage III received adjuvant chemotherapy. Age at diagnosis was the strongest determinant of chemotherapy. Among stage-II patients, those receiving chemotherapy decreased from 57.6% in patients aged <or=50 years to 1.1% in those aged >or=85. The corresponding percentages with stage III were 93.6% and 1.4%. In multivariate analyses, other factors found to be independently and significantly associated with administration of adjuvant chemotherapy for stage II were extension of the cancer (stage IIA vs. stage IIB), clinical presentation (obstruction or perforation vs. uncomplicated cancer) and discussion of the case at a multidisciplinary case-review meeting. For stage III, apart from age, discussion of the case at a multidisciplinary meeting was the only factor independently associated with administration of chemotherapy.
Adjuvant chemotherapy for stage-III colon cancer is used extensively for patients under 75 years of age. However, many elderly patients do not receive such treatment. On the other hand, a substantial percentage of stage-II colon cancer patients receive adjuvant chemotherapy despite its uncertain benefits.
尽管临床试验已证明辅助化疗可提高III期结肠癌患者的生存率，但对于II期病变，其益处仍存在争议。本研究的目的是确定辅助化疗在II期和III期结肠癌患者中的应用程度。
研究人群包括2000年在法国12个行政区诊断出并记录在基于人群的癌症登记处的1074例II期和III期结肠癌患者。数据通过标准化程序收集。
总体而言，20.4%的II期患者和61.9%的III期患者接受了辅助化疗。诊断时的年龄是化疗的最强决定因素。在II期患者中，接受化疗的患者比例从年龄≤50岁患者中的57.6%降至年龄≥85岁患者中的1.1%。III期患者的相应比例分别为93.6%和1.4%。在多变量分析中，发现与II期辅助化疗独立且显著相关的其他因素包括癌症范围（IIA期与IIB期）、临床表现（梗阻或穿孔与非复杂性癌症）以及在多学科病例审查会议上对病例的讨论。对于III期患者，除年龄外，在多学科会议上对病例的讨论是与化疗应用独立相关的唯一因素。
III期结肠癌的辅助化疗广泛应用于75岁以下的患者。然而，许多老年患者未接受此类治疗。另一方面，尽管益处不确定，但仍有相当比例的II期结肠癌患者接受辅助化疗。
