Ochiai Takumi, Nishimura Kazuhiko, Watanabe Tomoo, Kitajima Masayuki, Nakatani Akinori, Nagayasu Kiichi, Sakuyama Naoki, Sato Tsuyoshi, Kishine Kenji, Abe Yu, Nagaoka Isao
Department of Surgery, Tobu Chiiki Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo 125-8512, Japan.
Department of Host Defense and Biochemical Research, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Oncol Lett. 2019 Feb;17(2):1842-1850. doi: 10.3892/ol.2018.9805. Epub 2018 Dec 6.
In recent studies, better clinical outcomes for patients with left-sided colon cancer (CC) compared with right-sided CC have been reported; however, in such investigations, the chemotherapy regimens included molecular-targeting agents. To the best of our knowledge, the impact of primary tumor location as a predictive factor in patients suffering from CC treated with cytotoxic anticancer agents alone has not been investigated. The aim of the present study was to determine the impact of the primary tumor location as a predictive factor of patients undergoing the following cytotoxic anticancer agent regimens: Leucovorin and fluorouracil + oxaliplatin (FOLFOX) or Leucovorin and fluorouracil + irinotecan (FOLFIRI), using the collagen gel droplet-embedded drug sensitivity test (CD-DST). Between March 2008 and April 2017, tumor specimens were obtained from 133 patients suffering from colorectal cancer (CRC) who had not received preoperative chemotherapy. CD-DST was performed and the growth inhibition rate (IR) was determined in FOLFOX and FOLFIRI regimens. The associations between tumor location and IR values for each condition were evaluated. In the present study, the prognosis of patients receiving palliative chemotherapy as well as treatment with molecularly-targeted agents was also investigated. There were no significant differences in the IRs (%) of the two regimens using CD-DST for right-sided tumors compared with left-sided tumors, including or excluding the rectum. The median survival times of patients with right CC and left CC who had received palliative chemotherapy and treatment with molecularly-targeted agents were 960 and 1,348 days, respectively. Primary tumor location did not represent a predictive factor for the efficacy of treatment with cytotoxic anticancer agent regimens using CD-DST. However, patients suffering from left-sided CC were revealed to exhibit better clinical outcomes compared with patients suffering from right-sided CC when molecularly-targeted agent regimens were administered. Therefore, the results of the present study suggested that molecularly-targeted agents rather than cytotoxic anticancer agents may result in improved clinical outcomes for patients with CRC suffering from left-sided tumors.
在最近的研究中，有报告称左侧结肠癌（CC）患者的临床结局优于右侧CC患者；然而，在这类研究中，化疗方案包含分子靶向药物。据我们所知，原发性肿瘤位置作为仅接受细胞毒性抗癌药物治疗的CC患者的预测因素的影响尚未得到研究。本研究的目的是使用胶原凝胶滴包埋药物敏感性试验（CD-DST），确定原发性肿瘤位置作为接受以下细胞毒性抗癌药物方案治疗的患者的预测因素的影响：亚叶酸钙和氟尿嘧啶+奥沙利铂（FOLFOX）或亚叶酸钙和氟尿嘧啶+伊立替康（FOLFIRI）。2008年3月至2017年4月期间，从133例未接受术前化疗的结直肠癌（CRC）患者中获取肿瘤标本。进行CD-DST并确定FOLFOX和FOLFIRI方案中的生长抑制率（IR）。评估每种情况下肿瘤位置与IR值之间的关联。在本研究中，还调查了接受姑息化疗以及分子靶向药物治疗的患者的预后。使用CD-DST，右侧肿瘤与左侧肿瘤（包括或不包括直肠）的两种方案的IR（%）没有显著差异。接受姑息化疗和分子靶向药物治疗的右侧CC和左侧CC患者的中位生存时间分别为960天和1348天。原发性肿瘤位置不是使用CD-DST的细胞毒性抗癌药物方案治疗疗效的预测因素。然而，当给予分子靶向药物方案时，与右侧CC患者相比，左侧CC患者显示出更好的临床结局。因此，本研究结果表明，对于患有左侧肿瘤的CRC患者，分子靶向药物而非细胞毒性抗癌药物可能会改善临床结局。
