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围手术期化疗周期数对局部进展期直肠癌的预后价值:一项倾向评分匹配分析

Prognostic Value of the Cycle Number of Perioperative Chemotherapy in Locoregionally Advanced Rectal Cancer: a Propensity Score Matching Analysis.

作者信息

Chang Hui, Yu Xin, Chen Kai, Wang Qiao-Xuan, Zhang Shu, Zeng Zhi-Fan, Ding Pei-Rong, Pan Zhi-Zhong, Xiao Wei-Wei, Gao Yuan-Hong

机构信息

Department of Radiation Oncology, Sun Yat-sen University Cancer Center.

State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine.

出版信息

J Cancer. 2018 Oct 21;9(23):4346-4354. doi: 10.7150/jca.27251. eCollection 2018.


DOI:10.7150/jca.27251
PMID:30519339
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6277658/
Abstract

Appropriate cycle number of perioperative chemotherapy for patients with locoregionally advanced rectal cancer (LARC) remains unknown. This study aimed to evaluate how cycle number of perioperative chemotherapy influenced the prognosis of LARC patients. In this study, a total of 388 consecutive patients were enrolled and retrospectively reviewed if they were diagnosed with untreated stage cII-III LARC and treated with neoadjuvant chemoradiotherapy plus radical surgery followed by adjuvant chemotherapy or not. After grouping by the postoperative pathologic stage (yp0-I vs. ypII-III), propensity score matching was performed in each group to balance baseline characteristics between the patients treated with chemotherapy cycle ≤ 7 and those treated with chemotherapy cycle ≥ 8. The chemotherapy cycle was analyzed for its association with the survivals of the matched patients in the 2 groups, respectively. And the incidence of treatment-related complications was also compared. Through analysis, chemotherapy cycle ≥ 8 appeared to predict better overall, disease-free and distant-metastasis-free survivals in the whole cohort of matched patients ( values were 0.003, 0.002 and 0.004, respectively) and the ypII-III group ( values were 0.006, 0.005 and 0.014, respectively). But in the yp0-I group, chemotherapy of 8 cycles or more brought no improvement of survivals but only more acute toxicities (83.5% vs. 57.0%, < 0.001). Chemotherapy cycle ≥ 8 was proven associated with improved prognosis of LARC patients, especially those with ypII-III disease. But prolonged chemotherapy should be performed with caution in patients with yp0-I stage.

摘要

局部晚期直肠癌(LARC)患者围手术期化疗的合适周期数尚不清楚。本研究旨在评估围手术期化疗周期数如何影响LARC患者的预后。在本研究中,共纳入388例连续患者,回顾性分析他们是否被诊断为未经治疗的cII-III期LARC,以及是否接受新辅助放化疗加根治性手术,随后是否接受辅助化疗。按术后病理分期(yp0-I期与ypII-III期)分组后,在每组中进行倾向评分匹配,以平衡化疗周期≤7次和化疗周期≥8次的患者之间的基线特征。分别分析化疗周期与两组匹配患者生存率的相关性。并比较治疗相关并发症的发生率。通过分析,化疗周期≥8次似乎能预测匹配患者全队列(P值分别为0.003、0.002和0.004)和ypII-III组(P值分别为0.006、0.005和0.014)更好的总生存期、无病生存期和无远处转移生存期。但在yp0-I组中,8个周期或更多周期的化疗并未改善生存率,反而带来更多急性毒性(83.5%对57.0%,P<0.001)。化疗周期≥8次被证明与LARC患者预后改善相关,尤其是ypII-III期患者。但对于yp0-I期患者,延长化疗应谨慎进行。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/4e535e70e550/jcav09p4346g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/3178dae333e1/jcav09p4346g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/de704463aca0/jcav09p4346g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/33a1974fd8f3/jcav09p4346g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/4e535e70e550/jcav09p4346g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/3178dae333e1/jcav09p4346g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/de704463aca0/jcav09p4346g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/33a1974fd8f3/jcav09p4346g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f16f/6277658/4e535e70e550/jcav09p4346g004.jpg

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引用本文的文献

[1]
The number of cycles of adjuvant chemotherapy in stage III and high-risk stage II rectal cancer: a nomogram and recursive partitioning analysis.

World J Surg Oncol. 2022-4-12

[2]
Serum apolipoprotein B to apolipoprotein A-I ratio is an independent predictor of liver metastasis from locally advanced rectal cancer in patients receiving neoadjuvant chemoradiotherapy plus surgery.

BMC Cancer. 2022-1-3

[3]
Optimize the dose of oxaliplatin for locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by radical surgery and adjuvant chemotherapy.

BMC Cancer. 2020-6-1

本文引用的文献

[1]
Adjuvant Chemotherapy Seemed Not to Have Survival Benefit in Rectal Cancer Patients with ypTis-2N0 After Preoperative Radiotherapy and Surgery from a Population-Based Propensity Score Analysis.

Oncologist. 2018-4-19

[2]
Cancer incidence and mortality in China, 2014.

Chin J Cancer Res. 2018-2

[3]
Comparative Toxicity and Effectiveness of Trastuzumab-Based Chemotherapy Regimens in Older Women With Early-Stage Breast Cancer.

J Clin Oncol. 2017-10-10

[4]
Is there a prognostic value of tumor location among Chinese patients with colorectal cancer?

Oncotarget. 2017-6-13

[5]
Assessing the national trends in colon cancer among Native Americans: A 12 year SEER database study.

Am J Surg. 2017-8

[6]
Can we eliminate neoadjuvant chemoradiotherapy in favor of neoadjuvant multiagent chemotherapy for select stage II/III rectal adenocarcinomas: Analysis of the National Cancer Data base.

Cancer. 2017-3-1

[7]
High preoperative serum CA19-9 level is predictive of poor prognosis for patients with colorectal liver oligometastases undergoing hepatic resection.

Med Oncol. 2016-11

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Adjuvant FOLFOX treatment for stage III colon cancer: how many cycles are enough?

Springerplus. 2016-8-11

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Modified FOLFOX6 With or Without Radiation Versus Fluorouracil and Leucovorin With Radiation in Neoadjuvant Treatment of Locally Advanced Rectal Cancer: Initial Results of the Chinese FOWARC Multicenter, Open-Label, Randomized Three-Arm Phase III Trial.

J Clin Oncol. 2016-8-1

[10]
PAN-EX: a pooled analysis of two trials of neoadjuvant chemotherapy followed by chemoradiotherapy in MRI-defined, locally advanced rectal cancer.

Ann Oncol. 2016-5-23

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