Department of Surgery, Duke University, Durham, NC.
Department of Surgery, Duke University, Durham, NC.
J Am Coll Surg. 2018 Apr;226(4):670-678. doi: 10.1016/j.jamcollsurg.2017.12.048. Epub 2018 Jan 31.
Adjuvant chemotherapy after resection is the standard of care for stage III colon cancer, yet many patients omit chemotherapy. We aimed to describe the impact of delayed chemotherapy on overall survival across multiple time points.
The 2006 to 2014 National Cancer Data Base (NCDB) was queried for patients with single primary stage III adenocarcinoma of the colon. Patients were grouped by receipt and timing of chemotherapy from resection date: chemotherapy omitted, <6 weeks, 6 to 8 weeks, 8 to 12 weeks, 12 to 24 weeks, and >24 weeks. Subgroup analyses were performed for those with comorbidities and those who had postoperative complications. Overall survival was compared using Cox proportional hazard modeling, adjusting for patient, tumor, and facility characteristics.
In total, 72,057 patients were included; 20,807 omitted chemotherapy, 22,705 received it at <6 weeks, 15,412 between 6 and 8 weeks, 9,049 between 8 and 12 weeks, 3,595 between 12 and 24 weeks, and 489 at >24 weeks after resection. Compared with patients who omitted chemotherapy, patients who received chemotherapy at <6 weeks (hazard ratio [HR] 0.44), 6 to 8 weeks (HR 0.45), 8 to 12 weeks (HR 0.52), 12 to 24 weeks (HR 0.61), and >24 weeks (HR 0.68) had superior overall survival (p < 0.001). This survival benefit was preserved across subgroups (p < 0.001).
After resection of stage III colon cancer, patients should receive adjuvant chemotherapy within 6 to 8 weeks for maximal benefit. However, chemotherapy should be offered to patients who are outside the optimal window, who have significant comorbidities, or who have had a complication more than 24 weeks from resection to improve the overall survival compared with omitting chemotherapy.
术后辅助化疗是 III 期结肠癌的标准治疗方法，但许多患者会选择省略化疗。我们旨在描述在多个时间点，延迟化疗对总生存期的影响。
本研究检索了 2006 年至 2014 年国家癌症数据库（NCDB）中患有单一原发性 III 期结肠腺癌的患者数据。根据从手术日期开始接受化疗的时间和时机，患者分为以下几组：省略化疗、<6 周、6-8 周、8-12 周、12-24 周和>24 周。对合并症患者和术后并发症患者进行了亚组分析。使用 Cox 比例风险模型比较总生存期，调整患者、肿瘤和医疗机构特征。
共纳入 72057 例患者；20807 例患者省略了化疗，22705 例患者在<6 周内接受了化疗，15412 例患者在 6-8 周内接受了化疗，9049 例患者在 8-12 周内接受了化疗，3595 例患者在 12-24 周内接受了化疗，489 例患者在术后>24 周接受了化疗。与省略化疗的患者相比，<6 周（HR 0.44）、6-8 周（HR 0.45）、8-12 周（HR 0.52）、12-24 周（HR 0.61）和>24 周（HR 0.68）接受化疗的患者总生存期更好（p<0.001）。这一生存获益在各亚组中均得以保留（p<0.001）。
在 III 期结肠癌切除术后，为了获得最大获益，患者应在 6-8 周内接受辅助化疗。然而，对于那些错过最佳化疗时间窗的患者、合并症严重的患者或术后 24 周以上出现并发症的患者，应给予化疗，以提高总生存期，使其优于省略化疗。
