Seddik Youssef, Brahmi Sami Aziz, Afqir Said
Medical Oncology Department, University Hospital Mohammed VI, Oujda, Morocco.
Gulf J Oncolog. 2019 May;1(30):29-32.
In the locally advanced stage, the prognosis of rectal cancer was improved by preoperative chemoradiotherapy and radical surgery including complete total mesorectal excision. At present, the place of adjuvant chemotherapy remains controversial. We aimed to assess the impact of this chemotherapy on our patient survival.
This is a retrospective study including patients with locally advanced resectable cancer in the middle and low rectum, treated by neoadjuvant chemoradiotherapy and radical surgery including complete total mesorectal excision at the Medical Oncology Department of the University Hospital Mohammed VI-Oujda, Morocco over a period of six years from January 2007 to December 2012. Patients were divided into two groups: with chemotherapy (Group A) and without it (Group B). In group A, adjuvant chemotherapy was started 4-8 weeks after surgery, constituted of CAPOX (Capecitabine and oxaliplatin) or Capecitabine alone for 8 cycles. We assessed the median overall survival (OS), the median disease-free survival (DFS), the 3-year OS and the 3-year DFS in both groups.
Forty patients were included in this study. Nineteen patients in group A: CAPOX (n= 14), Capecitabine alone (n=5). Twenty-one patients in group B. After a median follow-up of 57 months (range 7-129). Median OS was 94 months in the group A and 119 months in group B [HR = 1.773, 95% CI: 0.759-1.773; P =0.186]. Median DFS was 30 months in group A and 17 months in group B [HR= 1.898, 95% CI: 0.634-5.683; P =0.252]. 3-year OS was 86.4% in group A and 92.5% in group B [HR= 1.549, 95% CI: 0.548- 4.383; p= 0.409]. 3-year DFS was 66.7% in group A and 57.2% in group B [HR=2.166, 95% CI: 0.712- 6.591; p= 0.173].
Although there are some limitations in our study, namely its retrospective design and small size of the cohort, adjuvant chemotherapy for locally advanced resectable rectal cancer treated with neoadjuvant chemoradiotherapy did not improve OS nor DFS.
在局部晚期阶段，术前放化疗以及包括完整直肠系膜全切除的根治性手术改善了直肠癌的预后。目前，辅助化疗的地位仍存在争议。我们旨在评估这种化疗对患者生存的影响。
这是一项回顾性研究，纳入了摩洛哥穆罕默德六世 - 乌季达大学医院肿瘤内科在2007年1月至2012年12月的6年期间接受新辅助放化疗及包括完整直肠系膜全切除的根治性手术的中低位局部晚期可切除直肠癌患者。患者分为两组：接受化疗组（A组）和未接受化疗组（B组）。在A组中，辅助化疗在术后4 - 8周开始，采用CAPOX方案（卡培他滨和奥沙利铂）或仅用卡培他滨，共8个周期。我们评估了两组的中位总生存期（OS）、中位无病生存期（DFS）、3年总生存率和3年无病生存率。
本研究共纳入40例患者。A组19例患者：CAPOX方案（n = 14），仅用卡培他滨（n = 5）。B组21例患者。中位随访57个月（范围7 - 129个月）后，A组中位总生存期为94个月，B组为119个月[风险比（HR）= 1.773，95%置信区间（CI）：0.759 - 1.773；P = 0.186]。A组中位无病生存期为30个月，B组为17个月[HR = 1.898，95% CI：0.634 - 5.683；P = 0.252]。A组3年总生存率为86.4%，B组为92.5%[HR = 1.549，95% CI：0.548 - 4.383；P = 0.409]。A组3年无病生存率为66.7%，B组为57.2%[HR = 2.166，95% CI：0.712 - 6.591；P = 0.173]。
尽管我们的研究存在一些局限性，即其回顾性设计和队列规模较小，但对于接受新辅助放化疗的局部晚期可切除直肠癌患者，辅助化疗并未改善总生存期和无病生存期。
