肥胖 III 期结肠癌患者化疗剂量减少的临床后果：来自 PETACC 3 研究的回顾性分析。
Clinical consequences of chemotherapy dose reduction in obese patients with stage III colon cancer: A retrospective analysis from the PETACC 3 study.
机构信息
University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany.
University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany.
出版信息
Eur J Cancer. 2018 Aug;99:49-57. doi: 10.1016/j.ejca.2018.05.004. Epub 2018 Jun 15.
BACKGROUND
Dose reduction in obese cancer patients has been replaced by fully weight-based dosing recommendations. No data, however, are available on the effects of dose reduction in obese stage III colon cancer patients undergoing adjuvant chemotherapy.
METHODS
Survival outcomes and toxicity data of obese (body mass index [BMI] ≥30 kg/m), stage III colon cancer patients treated within the phase III PETACC 3 trial comparing leucovorin, 5-FU (LV5FU2) with LV5FU2 plus irinotecan were analysed retrospectively according to chemotherapy dosing at first infusion (i.e. fully weight-based dosed - versus dose-reduced group). Multivariate analyses on relapse free survival (RFS) and overall survival (OS) were conducted to adjust for baseline prognostic factors using Cox regression model.
RESULTS
13.4% (280 of 2094 patients) had a BMI ≥ 30 kg/m, and 5.3% had both a BMI ≥ 30 kg/m and a body surface area (BSA) ≥2 m. Dose reductions occurred in 16.1% of patients with a BMI ≥ 30 kg/m and 32.4% with BMI ≥ 30 kg/m and BSA ≥ 2 m, respectively. In patients with BMI ≥ 30 kg/m, multivariate analysis demonstrated a trend towards better RFS in the fully dosed compared to the dose-reduced group (Hazard ratio (HR): 0.69, 95% CI: 0.43-1.09; p = 0.11); however, there was no statistically significant difference in OS. In patients with BMI ≥ 30 kg/m and BSA ≥ 2 m, multivariate analysis demonstrated better RFS in fully dosed compared with dose-reduced patients (HR: 0.48, 95% CI: 0.27-0.85; p = 0.01) and a strong trend towards better OS (HR: 0.53, 95% CI: 0.28-1.01; p = 0.052). This group comprised predominantly of men.
CONCLUSIONS
Data support the recommendation of using fully dosed chemotherapy for the adjuvant treatment in obese patients with colon cancer.
背景
在肥胖癌症患者中，已经将剂量减少替换为完全基于体重的剂量建议。然而，目前尚无关于接受辅助化疗的肥胖 III 期结肠癌患者减少剂量的效果的数据。
方法
回顾性分析了 III 期 PETACC 3 试验中接受比较亚叶酸、5-FU（LV5FU2）与 LV5FU2 加伊立替康的肥胖（体重指数[BMI]≥30 kg/m）、III 期结肠癌患者的生存结果和毒性数据，该试验根据首次输注时的化疗剂量（即完全按体重剂量组与剂量减少组）进行分析。使用 Cox 回归模型，通过多变量分析对无复发生存期（RFS）和总生存期（OS）进行调整，以调整基线预后因素。
结果
2094 例患者中有 13.4%（280 例）的 BMI≥30 kg/m，有 5.3%的 BMI≥30 kg/m且体表面积（BSA）≥2 m。BMI≥30 kg/m的患者中有 16.1%、BMI≥30 kg/m 且 BSA≥2 m 的患者中有 32.4%发生剂量减少。在 BMI≥30 kg/m 的患者中，多变量分析显示，与剂量减少组相比，完全剂量组的 RFS 有改善趋势（风险比（HR）：0.69，95%置信区间：0.43-1.09；p=0.11）；然而，OS 无统计学差异。在 BMI≥30 kg/m 且 BSA≥2 m 的患者中，多变量分析显示，与剂量减少组相比，完全剂量组的 RFS 更好（HR：0.48，95%置信区间：0.27-0.85；p=0.01），OS 有明显改善趋势（HR：0.53，95%置信区间：0.28-1.01；p=0.052）。该组主要由男性组成。
结论
数据支持对肥胖的结肠癌患者采用完全剂量化疗进行辅助治疗的建议。
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