Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta GA, USA.
Department of Biostatistics, Emory University, Atlanta GA, USA.
Oncologist. 2022 Sep 2;27(9):740-750. doi: 10.1093/oncolo/oyac082.
The survival impact of multi-agent (MAC) compared with single-agent (SAC) adjuvant chemotherapy (AC) in elderly patients with stage III colon cancer (CC) remains controversial. The aim of this study was to compare survival outcomes of MAC and SAC in this population utilizing the National Cancer Database (NCDB).
Patients aged ≥70 years with pathological stage III CC diagnosed in 2004-2015 were identified in the NCDB. Univariate and multivariable analyses were conducted, and Kaplan-Meier analysis and Cox proportional hazard models were used to identify associations between MAC vs. SAC and overall survival (OS).
Among 41 707 elderly patients (≥70 years old) with stage III CC, about half (n = 20 257; 48.5%) received AC; the majority (n = 12 923, 63.8%) received MAC. The median age was 79 (range 70-90). The majority were female (n = 11 201, 55.3%), Caucasians (88%) and had moderately differentiated tumor grade (n = 12 619, 62.3%), tumor size >4 cm (11 785, 58.2%), and negative surgical margins (18 496, 91.3%). Low-risk stage III CC constituted 50.6% (n = 10 264) of the study population. High-risk stage III CC was associated with worse OS compared with low-risk disease (HR 0.35, 0.34-0.36, P < .001). Multi-agent chemotherapy was associated with a better 5-year OS compared with SAC (P < .001). High-risk stage III patients who received MAC vs. SAC had an OS of 4.2 vs. 3.4 years, respectively (P < .001). Low-risk stage III patients who received MAC vs. SAC had a median OS of 8.5 vs. 7 years (P < .001). In univariate and multivariable analyses, male sex, positive surgical margin, insurance and facility types, age, year of diagnosis, tumor size, and Charlson-Deyo score of >2 were associated with worse OS (P < .05).
Any adjuvant chemotherapy has a trend of survival benefits. Multi-agent chemotherapy seems to have an enhanced benefit in the 70-75 age group. Multi-agent chemotherapy seemed to have similar efficacy as SAC in those aged >76 years.
在年龄较大的 III 期结肠癌（CC）患者中，多药联合（MAC）辅助化疗与单药（SAC）辅助化疗的生存影响仍存在争议。本研究旨在利用国家癌症数据库（NCDB）比较 MAC 和 SAC 在该人群中的生存结局。
从 NCDB 中确定了 2004-2015 年间诊断为 III 期 CC 且年龄≥70 岁的患者。进行了单因素和多因素分析，并使用 Kaplan-Meier 分析和 Cox 比例风险模型来确定 MAC 与 SAC 与总生存（OS）之间的关联。
在 41707 名年龄较大的（≥70 岁）III 期 CC 患者中，约一半（n=20257；48.5%）接受了 AC；大多数（n=12923，63.8%）接受了 MAC。中位年龄为 79 岁（范围 70-90 岁）。大多数是女性（n=11201，55.3%），白种人（88%），肿瘤分化程度中等（n=12619，62.3%），肿瘤大小>4cm（n=11785，58.2%），切缘阴性（n=18496，91.3%）。低危 III 期 CC 占研究人群的 50.6%（n=10264）。高危 III 期 CC 与低危疾病相比，OS 较差（HR 0.35，0.34-0.36，P <.001）。MAC 联合化疗与 SAC 相比，5 年 OS 更好（P <.001）。与 SAC 相比，接受 MAC 治疗的高危 III 期患者的 OS 分别为 4.2 年和 3.4 年（P <.001）。接受 MAC 治疗的低危 III 期患者的中位 OS 分别为 8.5 年和 7 年（P <.001）。在单因素和多因素分析中，男性、阳性切缘、保险和医疗机构类型、年龄、诊断年份、肿瘤大小和Charlson-Deyo 评分>2 与 OS 较差相关（P <.05）。
任何辅助化疗都有生存获益的趋势。MAC 似乎在 70-75 岁年龄组中获益更大。MAC 似乎在 76 岁以上患者中与 SAC 疗效相似。
