John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
The Angeles Clinic and Research Institute, Los Angeles, CA, USA.
J Gastrointest Surg. 2018 Feb;22(2):242-249. doi: 10.1007/s11605-017-3566-z. Epub 2017 Sep 20.
In 2016, the National Comprehensive Cancer Network included neoadjuvant chemotherapy as a treatment option for patients with clinical T4b colon cancer. However, there is little published data on the survival impact of neoadjuvant chemotherapy for locally advanced colon cancer.
Adult patients with non-metastatic clinically staged T3 or T4 colon cancer who underwent surgical resection were identified from the National Cancer Data Base between 2006 and 2014. Treatment was categorized as neoadjuvant chemotherapy followed by surgery and surgery followed by adjuvant chemotherapy. Overall survival was compared between the two groups using propensity score matching.
Of 27,575 patients that met inclusion criteria, 26,654 (97%) were treated with surgery followed by adjuvant chemotherapy and 921 (3%) received neoadjuvant chemotherapy followed by surgery. After propensity score matching, patients with T4b colon cancer treated with neoadjuvant chemotherapy had a 23% lower risk of death at 3 years compared to patients that had adjuvant chemotherapy (HR 0.77, 95% CI 0.60-0.98; p = 0.04). However, neoadjuvant chemotherapy did not demonstrate a similar significant benefit for patients with T3 and T4a disease.
Patients with clinical T4b colon cancer treated with neoadjuvant chemotherapy may have an improved survival compared to those who receive adjuvant chemotherapy. Further prospective investigation is warranted.
2016 年，美国国家综合癌症网络将新辅助化疗纳入临床 T4b 结肠癌患者的治疗选择。然而，关于新辅助化疗对局部晚期结肠癌的生存影响的发表数据很少。
从 2006 年至 2014 年，从国家癌症数据库中确定了接受手术切除的非转移性临床分期为 T3 或 T4 结肠癌的成年患者。将治疗分为新辅助化疗后手术和手术后辅助化疗。使用倾向评分匹配比较两组之间的总生存期。
在符合纳入标准的 27575 例患者中，26654 例（97%）接受了手术后辅助化疗，921 例（3%）接受了新辅助化疗后手术。在倾向评分匹配后，与接受辅助化疗的患者相比，接受新辅助化疗的 T4b 结肠癌患者在 3 年内死亡的风险降低了 23%（HR 0.77，95%CI 0.60-0.98；p=0.04）。然而，新辅助化疗对于 T3 和 T4a 疾病的患者并没有显示出类似的显著获益。
与接受辅助化疗的患者相比，接受新辅助化疗的临床 T4b 结肠癌患者的生存可能有所改善。需要进一步进行前瞻性研究。
