Mima Kosuke, Miyanari Nobutomo, Kosumi Keisuke, Tajiri Takuya, Kanemitsu Kosuke, Takematsu Toru, Inoue Mitsuhiro, Mizumoto Takao, Kubota Tatsuo, Baba Hideo
Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Int J Clin Oncol. 2021 May;26(5):903-912. doi: 10.1007/s10147-021-01876-1. Epub 2021 Jan 28.
The number of frail patients with colorectal cancer (CRC) has increased. Despite evidence-based treatment guidelines, a large proportion of patients with resected CRC do not receive adjuvant chemotherapy in daily practice. This retrospective study aimed to examine the effect of adjuvant chemotherapy for CRC according to frailty.
We retrospectively analyzed data from 507 consecutive patients with curatively resected high-risk stage II or stage III CRC between 2009 and 2016. Frailty was assessed using the Clinical Frailty Scale (CFS): 1 (very fit) to 9 (terminally ill), and frailty was defined as CFS ≥ 4. Recurrence-free survival (RFS) and overall survival (OS) were compared between surgery alone and adjuvant chemotherapy in frail and non-frail patients. A cox proportional hazards model was used to calculate hazard ratios (HRs), controlling for potential confounders.
Of the 507 patients, 194 (38%) were frail. There were no significant interactions between frailty and adjuvant chemotherapy regarding RFS (P = 0.59) and OS (P = 0.81). In multivariable analyses, associations of adjuvant chemotherapy with longer RFS and OS in frail patients (RFS, HR: 0.33, 95% CI 0.15-0.63; OS, HR: 0.23, 95% CI 0.08-0.54) were comparable to non-frail patients (RFS, HR: 0.36, 95% CI 0.22-0.58; OS, HR: 0.34, 95% CI 0.15-0.69). Frail patients receiving adjuvant chemotherapy were younger and had better nutritional status than those undergoing surgery alone (all P < 0.005).
Selected frail patients with CRC may experience a similar survival benefit from adjuvant chemotherapy as non-frail patients. Clinical trials are needed to establish adjuvant chemotherapy for CRC in frail patients.
患有结直肠癌（CRC）的虚弱患者数量有所增加。尽管有循证治疗指南，但在日常实践中，很大一部分接受了CRC切除手术的患者并未接受辅助化疗。这项回顾性研究旨在根据虚弱程度研究辅助化疗对CRC的疗效。
我们回顾性分析了2009年至2016年间连续507例接受根治性切除的高危II期或III期CRC患者的数据。使用临床虚弱量表（CFS）评估虚弱程度：1（非常健康）至9（临终），虚弱定义为CFS≥4。比较了虚弱和非虚弱患者单纯手术与辅助化疗后的无复发生存期（RFS）和总生存期（OS）。使用Cox比例风险模型计算风险比（HR），并对潜在混杂因素进行控制。
507例患者中，194例（38%）为虚弱患者。在RFS（P = 0.59）和OS（P = 0.81）方面，虚弱与辅助化疗之间无显著交互作用。在多变量分析中，辅助化疗与虚弱患者更长的RFS和OS相关（RFS，HR：0.33，95%CI 0.15 - 0.63；OS，HR：0.23，95%CI 0.08 - 0.54），这与非虚弱患者相当（RFS，HR：0.36，95%CI 0.22 - 0.58；OS，HR：0.34，95%CI 0.15 - 0.69）。接受辅助化疗的虚弱患者比单纯接受手术的患者更年轻，营养状况更好（所有P < 0.005）。
部分选定的CRC虚弱患者可能从辅助化疗中获得与非虚弱患者相似的生存获益。需要开展临床试验以确定CRC虚弱患者的辅助化疗方案。
