IDEA 数据库中的早发性结直肠腺癌：接受 3 个月和 6 个月辅助氟尿嘧啶和奥沙利铂治疗的依从性、毒性和结局。
Early-Onset Colorectal Adenocarcinoma in the IDEA Database: Treatment Adherence, Toxicities, and Outcomes With 3 and 6 Months of Adjuvant Fluoropyrimidine and Oxaliplatin.
机构信息
Sarah Cannon Research Institute UK, London, United Kingdom.
Gastrointestinal Tract Cancer Group, EORTC, Brussels, Belgium.
出版信息
J Clin Oncol. 2021 Dec 20;39(36):4009-4019. doi: 10.1200/JCO.21.02008. Epub 2021 Nov 9.
PURPOSE
Early-onset (EO) colorectal cancer (CRC, age < 50 years) incidence is increasing. Decisions on optimal adjuvant therapy should consider treatment adherence, adverse events, and expected outcomes in a population with life expectancy longer than later-onset (LO) CRC (age ≥ 50 years).
MATERIALS AND METHODS
Individual patient data from six trials in the International Duration Evaluation of Adjuvant Chemotherapy database were analyzed. Characteristics, treatment adherence, and adverse events in stage II or III EO-CRC and LO-CRC were compared. To reduce confounders of non-cancer-related deaths because of age or comorbidities, time to recurrence (3-year relapse-free rate) and cancer-specific survival (5-year cancer-specific mortality rate) were considered.
RESULTS
Out of 16,349 patients, 1,564 (9.6%) had EO-CRC. Compared with LO-CRC, EO-CRC had better performance status (86% 80%, < .01), similar T stage (% T1-3/T4: 76/24 77/23, = .97), higher N2 disease rate (24% 22%, < .01), more likely to complete the planned treatment duration (83.2% 78.2%, < .01), and received a higher treatment dose intensity, especially with 6-month regimens. Gastrointestinal toxicity was more common in EO-CRC; hematologic toxicity was more frequent in LO-CRC. Compared with LO-CRC, significantly worse cancer-specific outcomes were demonstrated especially in high-risk stage III EO-CRC: lower 3-year relapse-free rate (54% 65%; hazard ratio [HR] 1.33; 95% CI, 1.14 to 1.55; value < .001) and higher 5-year cancer-specific mortality rate (24% 20%; HR 1.21; 95% CI, 1.00 to 1.47; value < .06). In this subgroup, no difference was observed with 3 or 6 months of therapy, with equally poor disease-free survival rates (57% 56%; HR 0.97; 95% CI, 0.73 to 1.29; value = .85).
CONCLUSION
Young age is negatively prognostic in high-risk stage III CRC and associated with significantly higher relapse rate; this is despite better treatment adherence and higher administered treatment intensity, suggesting more aggressive disease biology.
目的
早发性（EO）结直肠癌（CRC，年龄<50 岁）的发病率正在上升。在预期寿命超过晚发性（LO）CRC（年龄≥50 岁）的人群中，决定最佳辅助治疗时应考虑治疗依从性、不良反应和预期结果。
材料和方法
对国际辅助化疗持续时间评估数据库中 6 项试验的个体患者数据进行了分析。比较了 II 期或 III 期 EO-CRC 和 LO-CRC 的特征、治疗依从性和不良反应。为了减少因年龄或合并症导致的非癌症相关死亡的混杂因素，考虑了复发时间（3 年无复发生存率）和癌症特异性生存（5 年癌症特异性死亡率）。
结果
在 16349 例患者中，有 1564 例（9.6%）患有 EO-CRC。与 LO-CRC 相比，EO-CRC 的表现状态更好（86%比 80%，<.01），T 分期相似（%T1-3/T4：76/24 比 77/23，=.97），N2 疾病发生率更高（24%比 22%，<.01），更有可能完成计划的治疗持续时间（83.2%比 78.2%，<.01），并且接受了更高的治疗剂量强度，尤其是 6 个月的治疗方案。EO-CRC 中胃肠道毒性更常见；LO-CRC 中血液学毒性更常见。与 LO-CRC 相比，EO-CRC 的癌症特异性结局明显更差，尤其是在高危 III 期 EO-CRC 中：3 年无复发生存率较低（54%比 65%；风险比[HR]1.33；95%CI，1.14 至 1.55； 值<.001），5 年癌症特异性死亡率较高（24%比 20%；HR 1.21；95%CI，1.00 至 1.47； 值<.06）。在该亚组中，3 个月或 6 个月的治疗没有差异，无病生存率同样较低（57%比 56%；HR 0.97；95%CI，0.73 至 1.29； 值=.85）。
结论
在高危 III 期 CRC 中，年轻的年龄是预后不良的因素，并与更高的复发率相关；尽管治疗依从性更好，治疗强度更高，但这表明疾病生物学更具侵袭性。
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