接受新辅助放化疗及全直肠系膜切除术的老年局部晚期直肠癌患者的肿瘤学及生存结局

Oncologic and survival outcomes in elderly patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy and total mesorectal excision.

作者信息

He Fang, Chen Mo, Xiao Wei-Wei, Zhang Qun, Liu Yanping, Zheng Jian, Wan Xiang-Bo, Gao Yuan-Hong

机构信息

Department of Radiation Oncology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, Guangzhou, China.

出版信息

Jpn J Clin Oncol. 2021 Aug 30;51(9):1391-1399. doi: 10.1093/jjco/hyab095.

DOI:10.1093/jjco/hyab095

PMID:34155513

Abstract

BACKGROUND

The efficacy of the addition of neoadjuvant chemotherapy to neoadjuvant chemoradiotherapy and total mesorectal excision for locally advanced rectal cancer in elderly patients has not been established.

METHODS

A total of 3096 locally advanced rectal cancer patients who received neoadjuvant chemotherapy, along with neoadjuvant chemoradiotherapy and total mesorectal excision, with or without adjuvant chemotherapy, between January 2010 and December 2018, were studied retrospectively. Patients were divided into elderly (>75 years) and younger (≤75 years) groups, and propensity score matching was used to balance a potentially confounding clinical bias. Overall survival, cancer-specific survival, disease-free survival, distant metastasis-free survival and local recurrence-free survival rates for the two groups were compared. Hazard ratios (HR) with 95% confidence intervals (CI) for different clinicopathological variables were calculated to determine predictors of 3-year overall survival.

RESULTS

Mean follow-up was 39.0 (range, 5-140) months. The overall 3-year overall survival, cancer-specific survival, disease-free survival, distant metastasis-free survival and locoregional relapse-free survival rates were 86.1, 87.6, 80.0, 82.4 and 95.4%, respectively. Only 3-year overall survival rates differed significantly between the elderly (77.2%) and younger (88.9%) groups (P = 0.01). Cancer-specific survival, disease-free survival, distant metastasis-free survival and locoregional relapse-free survival rates did not differ significantly between the two groups. Significant negative independent prognostic factors for 3-year overall survival were age >75 years (HR = 2.016, 95% CI 1.157-23.511, P = 0.01) and high pathologic TNM stage (yp stage III, P < 0.001).

CONCLUSION

For elderly locally advanced rectal cancer patients who have good health and performance status, the addition of neoadjuvant chemotherapy to neoadjuvant chemoradiotherapy and total mesorectal excision can result in disease-related survival rates and oncological outcomes similar to those experienced by younger patients. The decision to use this treatment approach in elderly patients should not be based solely on chronological age.

摘要

背景

对于老年局部晚期直肠癌患者，在新辅助放化疗及全直肠系膜切除的基础上加用新辅助化疗的疗效尚未明确。

方法

回顾性研究2010年1月至2018年12月期间共3096例接受新辅助化疗，以及新辅助放化疗和全直肠系膜切除，无论是否接受辅助化疗的局部晚期直肠癌患者。患者分为老年组（>75岁）和年轻组（≤75岁），采用倾向评分匹配法平衡潜在的混杂临床偏倚。比较两组的总生存、癌症特异性生存、无病生存、无远处转移生存和无局部复发生存率。计算不同临床病理变量的风险比（HR）及95%置信区间（CI），以确定3年总生存的预测因素。

结果

平均随访39.0（范围5 - 140）个月。总体3年总生存、癌症特异性生存、无病生存、无远处转移生存和无局部区域复发生存率分别为86.1%、87.6%、80.0%、82.4%和95.4%。老年组（77.2%）和年轻组（88.9%）仅3年总生存率差异有统计学意义（P = 0.01）。两组的癌症特异性生存、无病生存、无远处转移生存和无局部区域复发生存率差异无统计学意义。3年总生存的显著负性独立预后因素为年龄>75岁（HR = 2.016，95% CI 1.157 - 23.511，P = 0.01）和高病理TNM分期（yp III期，P < 0.001）。