Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
Department of Surgery, National Hospital Organization Nagasaki Medical Center, Ohmura, Nagasaki, Japan.
Int J Colorectal Dis. 2022 May;37(5):1181-1188. doi: 10.1007/s00384-022-04159-x. Epub 2022 Apr 27.
Although adjuvant chemotherapy (AC) using fluoro-pyrimidine and oxaliplatin (FU + oxaliplatin) is recommended after curative resection for locally advanced colon cancer patients, several randomized controlled trials have shown no additional effect of oxaliplatin in patients aged ≥ 70 years. Here, we examined the effectiveness of FU + oxaliplatin on the long-term outcome of old patients with a high risk of recurrence.
This multicenter, retrospective study included 346 colon cancer patients diagnosed with pathological T4 and/or N2 disease from 2016 to 2020. They were divided into an old group (≥ 70 years, n = 197) and a young group (< 70 years, n = 167). Propensity score matching was used to minimize selection bias, and 126 patients per group were matched.
Before matching, the rates of poor performance status (p < 0.001) and the presence of comorbidities (76.1% vs. 47.9%, p < 0.001) were higher in the old group. Although all baseline factors were similar between groups, after matching, the AC rate was lower in the old group (45.2% vs. 65.1%, p = 0.002). In the old group, relapse-free (82.2% vs. 55.6% and 69.6%, p < 0.05) and overall survival (83.1% vs. 80.0% and 44.4%, p < 0.05) rates were significantly higher in the AC patients with FU + oxaliplatin than in the AC patients with only FU and the non-AC patients.
The selected old colon cancer patients with a high risk of recurrence gained an additional benefit with respect to prognosis from FU + oxaliplatin as AC.
尽管氟嘧啶和奥沙利铂（FU+oxaliplatin）辅助化疗（AC）被推荐用于局部晚期结肠癌患者的根治性切除后，但几项随机对照试验表明，奥沙利铂对年龄≥70 岁的患者没有额外效果。在这里，我们研究了 FU+oxaliplatin 在复发风险较高的老年患者的长期预后中的有效性。
这项多中心回顾性研究纳入了 2016 年至 2020 年期间诊断为病理 T4 和/或 N2 疾病的 346 例结肠癌患者。他们分为老年组（≥70 岁，n=197）和年轻组（<70 岁，n=167）。采用倾向评分匹配法尽量减少选择偏倚，每组匹配 126 例患者。
在匹配前，老年组的身体状况不佳（p<0.001）和合并症的发生率（76.1% vs. 47.9%，p<0.001）较高。尽管两组的所有基线因素相似，但在匹配后，老年组的 AC 率较低（45.2% vs. 65.1%，p=0.002）。在老年组中，FU+oxaliplatin 辅助化疗组的无复发生存率（82.2% vs. 55.6%和 69.6%，p<0.05）和总生存率（83.1% vs. 80.0%和 44.4%，p<0.05）均显著高于 FU 单药辅助化疗组和非 AC 组。
选择具有高复发风险的老年结肠癌患者，FU+oxaliplatin 作为 AC 可获得额外的预后获益。
