Loree Jonathan M, Kennecke Hagen F, Renouf Daniel J, Lim Howard J, Vickers Michael M, Speers Caroline H, Cheung Winson Y
Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada.
Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.
Clin Colorectal Cancer. 2016 Dec;15(4):352-359.e1. doi: 10.1016/j.clcc.2016.04.003. Epub 2016 May 7.
Adjuvant chemotherapy (AC) is offered to patients with stage II rectal cancer, but its use is controversial. We examined population-based outcomes of patients with pathologic stage II rectal cancer treated with AC after preoperative short-course radiotherapy.
We included patients diagnosed with pathologic stage II tumors from 1999 to 2009 in British Columbia. The disease-specific survival (DSS), relapse-free (RFS), and overall survival (OS) were assessed. Multivariate models adjusting for age, gender, Eastern Cooperative Oncology Group, and high-risk features (ie, pT4, poor differentiation, < 12 lymph nodes removed, lymphovascular invasion, perineural invasion, or obstruction or perforation) were constructed.
Of 851 patients reviewed, 330 had received preoperative short-course radiotherapy, of whom 123 (37%) subsequently received AC. Patients treated with AC were younger (median age 61 vs. 73 years; P < .0001), reported better Eastern Cooperative Oncology Group status (P < .0001), and had more high-risk features (P < .0001). On univariate analysis, AC was associated with improved DSS (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.36-0.94; P = .028), RFS (HR, 0.62; 95% CI, 0.39-0.98; P = .043), and OS (HR, 0.42; 95% CI, 0.30-0.59; P < .0001). On multivariate analysis, these outcomes were not significant (DSS HR, 0.83; 95% CI, 0.43-1.61; P = .58; RFS HR, 0.82; 95% CI, 0.44-1.50; P = .51; OS HR, 0.62; 95% CI, 0.37-1.03; P = .064). Subgroup analysis suggested AC improved DSS (HR, 0.25; 95% CI, 0.07-0.89; P = .033), RFS (HR, 0.24; 95% CI, 0.07-0.85; P = .027), and OS (HR, 0.22; 95% CI, 0.069-0.70; P = .011) only in patients with ≥ 2-high risk features.
In the present population-based cohort of patients with stage II rectal cancer, AC did not improve the outcomes in unselected patients. In a small subgroup of patients with ≥ 2 risk factors, we noted improved outcomes with AC use.
辅助化疗（AC）适用于II期直肠癌患者，但其应用存在争议。我们研究了术前短程放疗后接受AC治疗的II期直肠癌患者基于人群的预后情况。
我们纳入了1999年至2009年在不列颠哥伦比亚省被诊断为II期病理肿瘤的患者。评估了疾病特异性生存（DSS）、无复发生存（RFS）和总生存（OS）情况。构建了调整年龄、性别、东部肿瘤协作组（ECOG）状态和高危特征（即pT4、低分化、切除淋巴结<12个、淋巴管浸润、神经周围浸润或梗阻或穿孔）的多变量模型。
在审查的851例患者中，330例接受了术前短程放疗，其中123例（37%）随后接受了AC治疗。接受AC治疗的患者更年轻（中位年龄61岁对73岁；P<.0001），ECOG状态更好（P<.0001），且高危特征更多（P<.0001）。单变量分析显示，AC与改善DSS（风险比[HR]，0.58；95%置信区间[CI]，0.36 - 0.94；P =.028）、RFS（HR，0.62；95%CI，0.39 - 0.98；P =.043）和OS（HR，0.42；95%CI，0.30 - 0.59；P<.0001）相关。多变量分析显示，这些结果无统计学意义（DSS HR，0.83；95%CI，0.43 - 1.61；P =.58；RFS HR，0.82；95%CI，0.44 - 1.50；P =.51；OS HR，0.62；95%CI，0.37 - 1.03；P =.064）。亚组分析表明，仅在具有≥2个高危特征的患者中，AC改善了DSS（HR，0.25；95%CI，0.07 - 0.89；P =.033）、RFS（HR，0.24；95%CI，0.07 - 0.85；P =.027）和OS（HR，0.22；95%CI，0.069 - 0.70；P =.011）。
在目前这个基于人群的II期直肠癌患者队列中，AC并未改善未选择患者的预后。在一小部分具有≥2个危险因素的患者中，我们注意到使用AC可改善预后。
