Ramaswamy Anant, Kothari Rushabh, Desouza Ashwin, Gupta Tarachand, Bairwa Sandeep, Kapoor Akhil, Kumar Amit, Ventrapati Pradeep, Ramadwar Mukta, Mandavkar Sarika, Chavan Nita, Saklani Avanish, Ostwal Vikas
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
South Asian J Cancer. 2019 Jul-Sep;8(3):160-165. doi: 10.4103/sajc.sajc_176_18.
Data regarding the practice of adjuvant chemotherapy, specifically with modified CAPOX, and survival outcomes in operated colon cancer patients from a nontrial cohort in a lower-middle income and low prevalence nation like India is scarce.
Patients who underwent upfront curative resection for colon cancer from January 2013 to December 2016 were analyzed for baseline variables and outcomes.
A total of 491 patients underwent curative resection in the predefined time period. The median age of the patients was 53 years (range: 17-87). Patients with Stage I, Stage II, and Stage III disease comprised 7.9%, 44.8%, and 45.4% of the entire cohort, respectively. Patients with Stage I cancer were observed. Adjuvant chemotherapy was planned for 384 patients (78.2%), with the doublet regimens (capecitabine-oxaliplatin, or 5-fluorouracil-oxaliplatin) being used commonly (77.6%). Common toxicities were Hand-foot syndrome (Grade 2/3 - 21.4%) and peripheral neuropathy (Grade 2/3 - 20.1%). About 85% of patients receiving monotherapy (capecitabine or 5 fluorouracil) and 81.2% of patients receiving doublet chemotherapy (mCAPOX or modified FOLFOX-7) completed their planned adjuvant treatment. With a median follow-up of 22 months, estimated 3 years event-free survival was 86%, and overall survival (OS) was 93.6%. Stage, younger age (<50 years), underlying cardiovascular abnormalities, need for dose reductions and noncompletion of planned chemotherapy predicted for inferior estimated 3-year OS on multivariate analysis.
Adjuvant chemotherapy especially with modified CAPOX appears well tolerated in the Indian population and early survival outcomes appear to be comparable to published literature.
在像印度这样的中低收入、低发病率国家，关于辅助化疗（特别是改良的CAPOX方案）的应用情况以及接受手术治疗的结肠癌患者生存结局的数据十分匮乏。
对2013年1月至2016年12月期间接受结肠癌根治性切除术的患者进行基线变量和结局分析。
在预定时间段内，共有491例患者接受了根治性切除术。患者的中位年龄为53岁（范围：17 - 87岁）。I期、II期和III期疾病的患者分别占整个队列的7.9%、44.8%和45.4%。观察到I期癌症患者。计划对384例患者（78.2%）进行辅助化疗，常用的双药方案（卡培他滨 - 奥沙利铂或5 - 氟尿嘧啶 - 奥沙利铂）占比77.6%。常见的毒性反应为手足综合征（2/3级 - 21.4%）和周围神经病变（2/3级 - 20.1%）。接受单药治疗（卡培他滨或5 - 氟尿嘧啶）的患者中约85%以及接受双药化疗（mCAPOX或改良FOLFOX - 7）的患者中81.2%完成了计划的辅助治疗。中位随访22个月，估计3年无事件生存率为86%，总生存率（OS）为93.6%。多因素分析显示，分期、年龄较轻（<50岁）、潜在心血管异常、需要降低剂量以及未完成计划化疗预示着3年总生存率较低。
辅助化疗，尤其是改良的CAPOX方案，在印度人群中似乎耐受性良好，早期生存结局似乎与已发表的文献相当。
