Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
Am J Clin Oncol. 2021 Aug 1;44(8):383-387. doi: 10.1097/COC.0000000000000834.
The objective of this study was to analyze patterns of adjuvant chemotherapy among patients with resected rectal adenocarcinomas following neoadjuvant chemoradiation and surgical resection.
Alberta Cancer Registry and other provincial electronic medical registries (2004 to 2018) identified patients with nonmetastatic rectal cancer who received neoadjuvant chemoradiation followed by surgical resection and either oxaliplatin-based or fluoropyrimidine-only adjuvant chemotherapy. Multivariable logistic regression analysis was then undertaken to identify factors associated with the use of either regimen. Kaplan-Meier survival estimates were used to compare overall survival between both groups and multivariable Cox regression analysis was then used to identify factors associated with worse overall survival.
A total of 532 patients who fulfilled eligibility criteria were included in the current study: 347 patients received adjuvant fluoropyrimidine-only chemotherapy and 185 patients received adjuvant oxaliplatin-based chemotherapy. The following variables were associated with use of fluoropyrimidine-only adjuvant chemotherapy: older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.02-1.06), higher Charlson comorbidity index (OR: 1.47; 95% CI: 1.00-2.15), and no involved lymph nodes in the surgical pathology (OR: 5.55; 95% CI: 3.66-8.41). Using Kaplan-Meier survival estimates, no difference in overall survival between patients treated with adjuvant oxaliplatin-based chemotherapy and those treated with adjuvant fluoropyrimidine-only chemotherapy was identified (P=0.152). Within multivariable Cox regression analysis, type of chemotherapy was not associated with a difference in overall survival (hazard ratio for fluoropyrimidine-only chemotherapy vs. oxaliplatin-based chemotherapy: 1.02; 95% CI: 0.61-1.71).
Oxaliplatin-based adjuvant chemotherapy is not associated with improved survival outcomes compared with fluoropyrimidine-only chemotherapy in this real-world study.
本研究旨在分析新辅助放化疗和手术切除后接受直肠腺癌切除术的患者辅助化疗的模式。
利用艾伯塔癌症登记处和其他省级电子医疗登记处（2004 年至 2018 年），确定接受新辅助放化疗和手术切除，且接受奥沙利铂为基础或氟嘧啶类药物单一辅助化疗的非转移性直肠癌患者。然后，采用多变量逻辑回归分析确定与两种方案使用相关的因素。采用 Kaplan-Meier 生存估计比较两组的总生存率，然后采用多变量 Cox 回归分析确定与总生存率较差相关的因素。
共有 532 名符合入选标准的患者纳入本研究：347 名患者接受辅助氟嘧啶类药物单一化疗，185 名患者接受奥沙利铂为基础的辅助化疗。与氟嘧啶类药物单一辅助化疗相关的变量包括：年龄较大（比值比 [OR]：1.04；95%置信区间 [CI]：1.02-1.06）、Charlson 合并症指数较高（OR：1.47；95% CI：1.00-2.15）和手术病理中无受累淋巴结（OR：5.55；95% CI：3.66-8.41）。使用 Kaplan-Meier 生存估计，接受奥沙利铂为基础辅助化疗和接受氟嘧啶类药物单一辅助化疗的患者在总生存率方面无差异（P=0.152）。在多变量 Cox 回归分析中，化疗类型与总生存率无差异（氟嘧啶类药物单一化疗与奥沙利铂为基础化疗的危险比：1.02；95%CI：0.61-1.71）。
在本真实世界研究中，与氟嘧啶类药物单一化疗相比，奥沙利铂为基础的辅助化疗并未改善生存结局。
