Tsuji Yasushi, Sugihara Kenichi
a KKR Sapporo Medical Center, Tonan Hospital - Medical Oncology , Sapporo , Japan.
b Tokyo Medical and Dental University , Tokyo , Japan.
Expert Opin Pharmacother. 2016;17(6):783-90. doi: 10.1517/14656566.2016.1145665. Epub 2016 Feb 22.
Colorectal cancer (CRC) is the third most common cancer in the western world and also in Japan. The key factors in curing CRC are early detection, surgery and adequate adjuvant chemotherapy if needed.
Based on the results of following pivotal adjuvant trials, FOLFOX or XELOX are considered standard adjuvant chemotherapy for patients with stage III colon cancer in the western countries. On the other hand, 5-FU based monotherapies showed favorable results as adjuvant chemotherapy in Japan providing comparable results to doublet strategies in the western countries. There are two key factors that could provide better outcome: D3 lymph node dissection (LND) and thorough pathological examinations.
I believe that oxaliplatin based adjuvant chemotherapy may not be suitable for at least substage IIIA patients who underwent D3 surgery and were diagnosed by thorough pathological examinations for the following two reasons: toxicities and strongly stage-dependent added benefit of oxaliplatin in overall survival. We are awaiting the final results of three Japanese ongoing trials focusing on oxaliplatin based adjuvant chemotherapy. These results will hopefully help us create and implement global guidelines for truly standardizing the management of colon cancer prevalent all over the world, and help physicians recommend the treatment strategy available to each patient.
结直肠癌（CRC）是西方世界以及日本第三大常见癌症。治愈CRC的关键因素是早期检测、手术以及必要时进行充分的辅助化疗。
基于以下关键辅助试验的结果，FOLFOX或XELOX被认为是西方国家III期结肠癌患者的标准辅助化疗方案。另一方面，在日本，基于5-氟尿嘧啶（5-FU）的单一疗法作为辅助化疗显示出良好效果，与西方国家的双联疗法效果相当。有两个关键因素可带来更好的结果：D3淋巴结清扫（LND）和全面的病理检查。
我认为基于奥沙利铂的辅助化疗可能不适用于至少是接受了D3手术且经全面病理检查确诊的IIIA期亚组患者，原因如下两点：毒性以及奥沙利铂在总生存期方面强烈的分期依赖性额外获益。我们正在等待三项日本正在进行的聚焦于基于奥沙利铂的辅助化疗试验的最终结果。这些结果有望帮助我们制定并实施全球指南，真正实现全球结肠癌管理的标准化，并帮助医生为每位患者推荐可用的治疗策略。
