转移性结直肠癌患者的基线体能状况预测总生存期,但不能预测一线奥沙利铂-氟嘧啶双联方案的疗效。

Baseline physical functioning status of metastatic colorectal cancer patients predicts the overall survival but not the activity of a front-line oxaliplatin-fluoropyrimidine doublet.

机构信息

Unit of Medical Oncology, Department of Gastrointestinal Tumour, National Tumour Institute, Naples, Italy.

出版信息

Acta Oncol. 2010;49(1):50-6. doi: 10.3109/02841860903369540.

Abstract

BACKGROUND

No differences in response rate (RR), progression-free survival (PFS), overall survival (OS) and quality of life (QoL) were seen in patients randomly treated with biweekly oxaliplatin plus either fluorouracil/folinic acid or capecitabine.

METHODS

We investigated the independent effect of baseline clinical characteristics and physical functioning (PF) domain on RR, PFS, and OS in 310 patients who completed the EORTC QLQ-C30 questionnaire. Multivariate analyses stratified by treatment were performed. An exploratory analysis was done by grouping patients with a PF score superior or equal to the highest quartile (n = 111), included between the highest and the lowest quartiles (n = 99), or inferior to the lowest quartile (n = 100). The relationship between these three groups and the ECOG PS was then analysed.

RESULTS

At multivariate analysis, OS was negatively affected by the number of metastatic sites, the serum alkaline phosphatase, and the ECOG PS, while it was positively affected by the previous surgical resection of the primary tumour. Adding the baseline PF score, the number of disease sites (p < 0.0001), the serum alkaline phosphatase (p = 0.0057), and the PF (p = 0.0007) retained an independent significance, while the ECOG PS and the previous surgery were no longer significant. PF did not significantly affect PFS or RR. A good but not totally overlapping correlation was found between PF grouping and ECOG PS score.

CONCLUSIONS

Baseline self-reported PF independently predicted the OS of patients. Assessment of QoL should be incorporated in randomised trials evaluating the management of patients with MCRC.

摘要

背景

接受两周一次奥沙利铂联合氟尿嘧啶/亚叶酸或卡培他滨治疗的患者,其缓解率(RR)、无进展生存期(PFS)、总生存期(OS)和生活质量(QoL)无差异。

方法

我们调查了 310 名完成 EORTC QLQ-C30 问卷的患者基线临床特征和身体功能(PF)对 RR、PFS 和 OS 的独立影响。对治疗进行分层的多变量分析。通过将 PF 评分高于或等于最高四分位数(n = 111)、高于和低于最低四分位数之间的患者分组(n = 99)或低于最低四分位数(n = 100)进行了探索性分析。然后分析了这三组与 ECOG PS 的关系。

结果

多变量分析显示,OS 受转移灶数量、血清碱性磷酸酶和 ECOG PS 的影响,而受原发性肿瘤手术切除的影响为正。加入基线 PF 评分,疾病部位数量(p < 0.0001)、血清碱性磷酸酶(p = 0.0057)和 PF(p = 0.0007)仍具有独立意义,而 ECOG PS 和手术切除不再有意义。PF 对 PFS 或 RR 没有显著影响。PF 分组与 ECOG PS 评分之间存在良好但不完全重叠的相关性。

结论

基线自我报告的 PF 独立预测了患者的 OS。在评估转移性结直肠癌患者管理的随机试验中,应纳入 QoL 评估。

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