van Erning F N, Rutten H J T, van den Berg H A, Lemmens V E P P, van Halteren H K
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Eur J Surg Oncol. 2015 Dec;41(12):1630-5. doi: 10.1016/j.ejso.2015.09.011. Epub 2015 Sep 26.
Adjuvant chemotherapy still is a controversial therapy for rectal cancer patients. The aim of this study was to analyze the effect of adjuvant chemotherapy on recurrence-free survival (RFS) for patients with stage III rectal cancer treated in clinical practice, taking into account which neo-adjuvant treatment patients received.
Patients from regions in the Netherlands diagnosed between 1996 and 2013 with pathological stage III rectal cancer who received short-course radiotherapy, chemoradiation or no neo-adjuvant treatment and who underwent surgery were included. After stratification by neo-adjuvant treatment, 5-year RFS according to adjuvant chemotherapy receipt was calculated using Kaplan-Meier curves. Cox regression was used to discriminate the independent effect of adjuvant chemotherapy on the risk of recurrence/death.
The study population consisted of 829 patients, of whom 537 (65%) patients received short-course radiotherapy, 128 (15%) patients received chemoradiation and 164 (20%) patients received no neo-adjuvant treatment. Adjuvant chemotherapy was administered to 152 (18%) patients. Adjuvant chemotherapy was associated with improved 5-year RFS for patients who received short-course radiotherapy (61% vs. 46%, p = 0.005) and for patients who did not receive any neo-adjuvant treatment (70% vs. 28%, p < 0.0001). In multivariable analyses, adjuvant chemotherapy was associated with a reduced risk of recurrence/death for patients treated with short-course radiotherapy (HR 0.65, 95% CI 0.46-0.93) and for patients without neo-adjuvant treatment (HR 0.35, 95% CI 0.18-0.71), but not for patients treated with chemoradiation (HR 1.11, 95% CI 0.51-2.41).
Among patients with stage III rectal cancer, the effect of adjuvant chemotherapy on RFS seems to vary by neo-adjuvant treatment.
辅助化疗对于直肠癌患者而言仍是一种存在争议的治疗方法。本研究的目的是分析在临床实践中接受新辅助治疗的III期直肠癌患者辅助化疗对无复发生存期（RFS）的影响。
纳入1996年至2013年间在荷兰地区被诊断为病理III期直肠癌、接受短程放疗、同步放化疗或未接受新辅助治疗且接受了手术的患者。在按新辅助治疗分层后，使用Kaplan-Meier曲线计算根据辅助化疗接受情况的5年无复发生存率。采用Cox回归分析辅助化疗对复发/死亡风险的独立影响。
研究人群包括829例患者，其中537例（65%）接受短程放疗，128例（15%）接受同步放化疗，164例（20%）未接受新辅助治疗。152例（18%）患者接受了辅助化疗。辅助化疗与接受短程放疗患者的5年无复发生存率提高相关（61%对46%，p = 0.005），与未接受任何新辅助治疗的患者的5年无复发生存率提高相关（70%对28%，p < 0.0001）。在多变量分析中，辅助化疗与接受短程放疗患者（HR 0.65，95%CI 0.46 - 0.93）和未接受新辅助治疗患者（HR 0.35，95%CI 0.18 - 0.71）的复发/死亡风险降低相关，但与接受同步放化疗的患者无关（HR 1.11，95%CI 0.51 - 2.41）。
在III期直肠癌患者中，辅助化疗对无复发生存期的影响似乎因新辅助治疗而异。
