Aparicio Thomas, Gargot Dany, Teillet Laurent, Maillard Emilie, Genet Dominique, Cretin Jacques, Locher Christophe, Bouché Olivier, Breysacher Gilles, Seitz Jean-François, Gasmi Mohamed, Stefani Laetitia, Ramdani Mohamed, Lecomte Thierry, Auby Dominique, Faroux Roger, Bachet Jean-Baptiste, Lepère Céline, Khemissa Faiza, Sobhani Iradj, Boulat Olivier, Mitry Emmanuel, Jouve Jean-Louis
Gastroenterology Department, CHU Saint Louis, APHP, Université Paris 7, Sorbonne Paris Cité, Paris, France.
Gastroenterology Department, CH Blois, Blois, France.
Eur J Cancer. 2017 Mar;74:98-108. doi: 10.1016/j.ejca.2016.09.029. Epub 2016 Nov 5.
Several predictors of metastatic colorectal cancer (mCRC) outcomes have been described. Specific geriatric characteristics could be of interest to determine prognosis.
Elderly patients (75+) with previously untreated mCRC were randomly assigned to receive infusional 5-fluorouracil-based chemotherapy, either alone (FU) or in combination with irinotecan (IRI). Geriatric evaluations were included as an optional procedure. The predictive value of geriatric parameters was determined for the objective response rate (ORR), progression-free survival (PFS) and overall survival (OS).
From June 2003 to May 2010, the FFCD 2001-02 randomised trial enrolled 282 patients. A baseline geriatric evaluation was done in 123 patients; 62 allocated to the FU arm and 61 to the IRI arm. The baseline Charlson index was ≤1 in 75%, Mini-Mental State Examination was ≤27/30 in 31%, Geriatric Depression Scale was >2 in 10% and Instrumental Activities of Daily Living (IADL) was impaired in 34% of the patients. Multivariate analyses revealed that no geriatric parameter was predictive for ORR or PFS. Normal IADL was independently associated with better OS. The benefit of doublet chemotherapy on PFS differed in subgroups of patients ≤80 years, with unresected primary tumour, leucocytes >11,000 mm and carcinoembryonic antigen >2N. There was a trend towards better OS in patients with normal IADL.
The autonomy score was an independent predictor for OS. A trend toward a better efficacy of doublet chemotherapy in some subgroups of patients was reported and should be further explored.
已描述了转移性结直肠癌（mCRC）预后的几种预测因素。特定的老年特征可能有助于确定预后。
将先前未接受过治疗的老年患者（75岁及以上）随机分配接受基于5-氟尿嘧啶的输注化疗，单独使用（FU）或与伊立替康（IRI）联合使用。老年评估作为一项可选程序纳入。确定老年参数对客观缓解率（ORR）、无进展生存期（PFS）和总生存期（OS）的预测价值。
从2003年6月至2010年5月，FFCD 2001 - 02随机试验纳入了282例患者。123例患者进行了基线老年评估；62例分配至FU组，61例分配至IRI组。75%的患者基线查尔森指数≤1，31%的患者简易精神状态检查表评分≤27/30，10%的患者老年抑郁量表评分>2，34%的患者日常生活活动能力量表（IADL）受损。多变量分析显示，没有老年参数可预测ORR或PFS。IADL正常与更好的OS独立相关。双联化疗对PFS的益处在年龄≤80岁、有未切除原发肿瘤、白细胞>11,000/mm³和癌胚抗原>2N的患者亚组中有所不同。IADL正常的患者有OS更好的趋势。
自主评分是OS的独立预测因素。报告了双联化疗在某些患者亚组中疗效更好的趋势，应进一步探索。
