Hassan Astrid Sinarti, Naicker Manimalar, Yusof Khairul Hazdi, Wan Ishak Wan Zamaniah
Clinical Oncology Unit, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia E-mail :
Asian Pac J Cancer Prev. 2015;16(6):2237-43. doi: 10.7314/apjcp.2015.16.6.2237.
Adjuvant chemotherapy improves survival in Dukes C colon cancers post-curative resection. However, the evidence for a role with Dukes B lesions remains unproven despite frequent use for disease characterized by poor prognostic features. In view of limited Asia-specific data, this study aimed to determine survival outcomes and identify prognostic factors in a tertiary teaching hospital in Malaysia.
A total of 116 subjects who underwent curative surgery with and without adjuvant chemotherapy for Duke B and C primary colon adenocarcinomas diagnosed from 2004-2009 were recruited and data were collected retrospectively. Five-year overall survival (OS) and disease free survival (DFS) were analysed using Kaplan-Meier survival analysis and log-rank (Mantel-Cox) test. Prognostic factors were determined using Cox proportional hazards regression with both univariate and multivariate analyses.
The survival analysis demonstrated a 5-year OS of 74.0% for all patients, with 74.9% for Dukes C subjects receiving chemotherapy compared to 28.6% in those not receiving chemotherapy (p=0.001). For Dukes B disease, the 5-year survival rate was 82.6% compared to 75.0% for subjects receiving and not receiving chemotherapy, respectively (p=0.17). Independent prognostic factors identified included a CEA level more than 3.5 ng/ml (hazard ratio (HR)=4.78; p=0.008), serosal involvement (HR=3.75; p=0.028) and completion of chemotherapy (HR= 0.20; p=0.007).
In a regional context, this study supports current evidence from the West that adjuvant chemotherapy improves survival in Dukes C colon cancers post curative surgery. However, although a clear benefit has yet to be proven for Dukes B disease, our results suggest survival improvement in selected cases.
辅助化疗可提高 Dukes C 期结肠癌根治性切除术后的生存率。然而，尽管 Dukes B 期病变因预后特征较差而常使用辅助化疗，但其作用的证据仍未得到证实。鉴于亚洲地区特异性数据有限，本研究旨在确定马来西亚一家三级教学医院中患者的生存结局并识别预后因素。
共招募了 116 例在 2004 年至 2009 年期间被诊断为 Duke B 期和 C 期原发性结肠腺癌并接受了根治性手术（有或无辅助化疗）的患者，并对数据进行回顾性收集。采用 Kaplan-Meier 生存分析和对数秩（Mantel-Cox）检验分析 5 年总生存率（OS）和无病生存率（DFS）。使用 Cox 比例风险回归进行单因素和多因素分析以确定预后因素。
生存分析显示，所有患者的 5 年 OS 为 74.0%，接受化疗的 Dukes C 期患者为 74.9%，未接受化疗的患者为 28.6%（p = 0.001）。对于 Dukes B 期疾病，接受化疗和未接受化疗的患者 5 年生存率分别为 82.6%和 75.0%（p = 0.17）。确定的独立预后因素包括癌胚抗原（CEA）水平超过 3.5 ng/ml（风险比（HR）= 4.78；p = 0.008）、浆膜受累（HR = 3.75；p = 0.028）和完成化疗（HR = 0.20；p = 0.007）。
在本地区范围内，本研究支持西方目前的证据，即辅助化疗可提高 Dukes C 期结肠癌根治性手术后的生存率。然而，尽管 Dukes B 期疾病的明确获益尚未得到证实，但我们的结果表明在某些病例中生存率有所提高。
