Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico0.
PLoS One. 2018 Mar 27;13(3):e0194415. doi: 10.1371/journal.pone.0194415. eCollection 2018.
This study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival.
This retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008-2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively.
Overall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18-2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03-2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06-2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14-0.36; p<0.001).
We observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.
本研究旨在探讨与 III 期结肠癌患者根治术后辅助化疗和奥沙利铂使用相关的因素，并评估其使用对 3 年生存率的影响。
这是一项使用波多黎各中央癌症登记处-健康保险关联数据库进行的回顾性队列研究。研究队列包括 2008 年至 2012 年期间接受根治性手术的 III 期结肠癌患者。采用多变量逻辑回归估计调整后的优势比。Kaplan-Meier 方法和 Cox 比例风险模型分别用于评估辅助化疗和奥沙利铂使用与总生存和死亡风险之间的关联。
总体而言，研究人群中有 75%在研究期间接受了辅助化疗。在根治术后 4 个月内接受辅助化疗的统计学相关因素包括已婚（调整后的优势比 [OR] 1.64；95%置信区间 [CI] 1.18-2.28；p = 0.003），以及参加医疗保险（OR 1.68；95%CI：1.03-2.75；p = 0.039）或医疗补助和医疗保险双重资格（OR 1.66；95%CI：1.06-2.60；p = 0.028）。然而，年龄≥70 岁的患者接受辅助化疗的可能性较低（OR 0.22；95%CI 0.14-0.36；p<0.001）。
我们观察到接受辅助化疗的患者死亡率显著降低。同样，<70 岁接受奥沙利铂治疗的患者死亡风险明显低于未接受治疗的患者，尽管≥70 岁的患者未达到统计学意义。未来的研究应评估有效的干预措施，以减少获得基于指南的结肠癌治疗的障碍。
