Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
J Cancer Res Clin Oncol. 2018 May;144(5):909-923. doi: 10.1007/s00432-018-2611-y. Epub 2018 Feb 19.
The extent to which ≥ 70 year patients with colon cancer benefit from adjuvant chemotherapy in the presence of competing risks remains controversial.
18,937 patients ≥ 70 years with high-risk stage II and stage III colon cancer were retrospectively reviewed from SEER database. Propensity score matching (PSM) was used to adjust for potential baseline confounding. The nomograms were developed based on the competing model to describe the individual probability of colon cancer-specific death (CCSD) and non-CCSD. The subpopulation treatment-effect pattern plot (STEPP) was used to estimate the treatment-effect heterogeneity.
In the high-risk stage II subgroup, compared to the non-recipients, the hazard ratios (HR) of overall mortality for recipients were 0.83 (P = 0.001). The subdistribution hazard ratio (SHR) of CCSD for receipts was 1.22 (P = 0.021). The SHR of non-CCSD was 0.63 (P < 0.001). In the stage III subgroup, compared to non-recipients, the HR of the overall mortality for the recipients was 0.62 (P < 0.001). The SHR of CCSD was 0.77 (P < 0.001). The SHR of non-CCSD was 0.58 (P < 0.001). The chemotherapy efficacy differed significantly by risk score of non-CCSD (non-CCSD-RS) (P < 0.001). Recipients with high non-CCSD-RS had a rate of CCSD comparative to that of non-recipients (SHR 0.90, P = 0.150) in the stage III subgroup.
A survival analysis based on the overall mortality did not correctly interpret the effect of chemotherapy. Adjuvant chemotherapy did not provide an additional benefit to patients with high-risk stage II or patients with stage III at high risk of non-cancer death.
在存在竞争风险的情况下，≥70 岁的结肠癌患者接受辅助化疗的获益程度仍存在争议。
从 SEER 数据库中回顾性分析了 18937 名≥70 岁的高危 II 期和 III 期结肠癌患者。采用倾向评分匹配（PSM）调整潜在的基线混杂因素。基于竞争模型开发了列线图，以描述结肠癌特异性死亡（CCSD）和非 CCSD 的个体概率。采用亚组治疗效果模式图（STEPP）估计治疗效果的异质性。
在高危 II 期亚组中，与非接受者相比，接受者的总死亡率的风险比（HR）为 0.83（P=0.001）。接受者的 CCSD 的亚分布风险比（SHR）为 1.22（P=0.021）。非 CCSD 的 SHR 为 0.63（P<0.001）。在 III 期亚组中，与非接受者相比，接受者的总死亡率的 HR 为 0.62（P<0.001）。CCSD 的 SHR 为 0.77（P<0.001）。非 CCSD 的 SHR 为 0.58（P<0.001）。非 CCSD 的风险评分（非 CCSD-RS）差异显著（P<0.001）。在 III 期亚组中，高非 CCSD-RS 的接受者的 CCSD 发生率与非接受者相当（SHR 0.90，P=0.150）。
基于总死亡率的生存分析并未正确解释化疗的效果。辅助化疗并未为高危 II 期或高危 III 期患者（非癌症死亡风险高）带来额外获益。
