Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.
Cancer Med. 2020 Mar;9(5):1613-1627. doi: 10.1002/cam4.2843. Epub 2020 Jan 21.
Factors that are prognostic of early discontinuation of adjuvant chemotherapy among stage III colon cancer patients have yet to be described. To address this gap, a survey of medical oncologists and a systematic review and meta-analysis were conducted.
A survey was distributed in March 2019 to medical oncologists who treat colon cancer within Alberta, Canada. Clinicians were asked to rank the prognostic importance of a set of variables using a Likert scale and agreement was quantified using a weighted Cohen's kappa. In addition, we systematically searched four databases up to July 2019. Meta-analyses were conducted using a random-effects model.
Of the 25 clinicians who were sent the survey, 14 responded. Overall, there was no agreement regarding which variables were prognostic of early discontinuation (weighted Cohen's kappa = 0.12; 95% CI = 0.05-0.18). From an initial 3927 articles, 18 investigations were identified for inclusion in our review. Based upon evidence from both the survey and the systematic review, the following four variables were identified as being prognostic of early discontinuation: (a) comorbidity (OR = 1.53; 95% CI = 1.30-1.79); (b) performance status (OR = 1.33; 95%CI = 1.07-1.65); (c) T stage (OR = 1.57; 95% CI = 0.99-2.50); and (d) chemotherapy regimen (estimates not pooled due to heterogeneity). In addition to these factors, there was some suggestion that age, marital status/social support, muscle mass, N stage, and tumor grade had prognostic value.
Current evidence is heterogeneous and limited. Additional research is needed to confirm our findings and to explore additional prognostic factors.
目前尚未描述预测 III 期结肠癌患者辅助化疗早期停药的预后因素。为解决这一差距，进行了一项医学肿瘤学家调查以及系统评价和荟萃分析。
2019 年 3 月，向在加拿大艾伯塔省治疗结肠癌的医学肿瘤学家分发了一项调查。临床医生被要求使用李克特量表对一组变量的预后重要性进行排名，并使用加权 Cohen's kappa 量化一致性。此外，我们还系统地检索了截至 2019 年 7 月的四个数据库。使用随机效应模型进行荟萃分析。
在发送调查的 25 名临床医生中，有 14 名做出了回应。总体而言，对于哪些变量具有早期停药的预后意义，临床医生之间没有达成一致意见（加权 Cohen's kappa = 0.12；95%CI = 0.05-0.18）。从最初的 3927 篇文章中，确定了 18 项研究纳入我们的综述。基于调查和系统评价的证据，确定了以下四个变量具有早期停药的预后意义：（a）合并症（OR = 1.53；95%CI = 1.30-1.79）；（b）体能状态（OR = 1.33；95%CI = 1.07-1.65）；（c）T 分期（OR = 1.57；95%CI = 0.99-2.50）；（d）化疗方案（由于异质性，未对估计值进行汇总）。除了这些因素外，还有一些证据表明年龄、婚姻状况/社会支持、肌肉量、N 分期和肿瘤分级具有预后价值。
目前的证据存在异质性且有限。需要进一步研究来证实我们的发现并探索其他预后因素。
