姑息化疗剂量调整对转移性结直肠癌生存影响。

The survival impact of palliative chemotherapy dose modifications on metastatic colon cancer.

机构信息

Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan, Bangi, Malaysia.

National Cancer Institute, Ministry of Health, Putrajaya, Malaysia.

出版信息

BMC Cancer. 2022 Jul 4;22(1):731. doi: 10.1186/s12885-022-09831-7.

DOI:10.1186/s12885-022-09831-7

PMID:35787795

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9254497/

Abstract

BACKGROUND

An uninterrupted dose of oxaliplatin-based cytotoxic therapy is an essential component in the standard treatment regimen of metastatic colon cancer (mCC). Data on the impacts of dose intensity reduction on the palliative treatment for patients with mCC remain scarce. Hence, this study aimed to investigate the impact of palliative chemotherapy dose modifications (DM) on the survival of patients with mCC.

METHODS

Patients with stage IV colon cancer who received first-line palliative FOLFOX regimen chemotherapy between 2014 until 2018 in the Oncology Department of the National Cancer Institute were conveniently sampled retrospectively to analyse the treatment efficacy. The cumulative dose and duration of chemotherapy received by the patients were summarised as relative dose intensity (RDI) and stratified as High RDI (RDI ≥ 70%) or Low RDI (RDI < 70%). Progression-free survival (PFS) and 2-year overall survival (OS) between the two groups were analysed using Kaplan-Meier survival analysis and Cox proportional hazards models.

RESULTS

Out of the 414 patients identified, 95 patients with mCC were eligible and included in the final analysis. About half of the patients (n = 47) completed the 12-cycle chemotherapy regimen and one patient received the complete (100%) RDI. The overall median RDI was 68.7%. The Low RDI group (n = 49) had a 1.5 times higher mortality risk than the High RDI group [OS, Hazard Ratio (HR) = 1.5, 95% Cl: 1.19-1.82] with a significant median OS difference (9.1 vs. 16.0 months, p < 0.01). Furthermore, patients with lower dose intensity showed double the risk of disease progression (PFS, HR = 2.0, 95% CI: 1.23-3.13) with a significant difference of 4.5 months of median PFS (p < 0.01). Gender and RDI were the independent prognostic factors of both OS and PFS.

CONCLUSION

Reduction in the dose intensity of palliative chemotherapy may adversely affect both disease progression and overall survival among mCC patients.

摘要

背景

奥沙利铂为基础的细胞毒性药物连续不间断剂量是转移性结直肠癌（mCRC）标准治疗方案的重要组成部分。关于剂量强度降低对 mCRC 患者姑息治疗影响的数据仍然很少。因此，本研究旨在探讨姑息化疗剂量调整（DM）对 mCRC 患者生存的影响。

方法

回顾性便利抽样选取 2014 年至 2018 年在国家癌症研究所肿瘤内科接受一线姑息性 FOLFOX 方案化疗的 IV 期结直肠癌患者，分析治疗效果。总结患者接受的化疗累积剂量和持续时间作为相对剂量强度（RDI），并分为高 RDI（RDI≥70%）或低 RDI（RDI<70%）。采用 Kaplan-Meier 生存分析和 Cox 比例风险模型分析两组间无进展生存期（PFS）和 2 年总生存期（OS）。

结果

在确定的 414 例患者中，95 例 mCRC 患者符合条件并纳入最终分析。大约一半的患者（n=47）完成了 12 周期化疗方案，1 例患者接受了完整（100%）RDI。总体中位数 RDI 为 68.7%。低 RDI 组（n=49）的死亡率是高 RDI 组的 1.5 倍[OS，风险比（HR）=1.5，95%置信区间：1.19-1.82]，中位 OS 差异有统计学意义（9.1 与 16.0 个月，p<0.01）。此外，剂量强度较低的患者疾病进展风险增加一倍（PFS，HR=2.0，95%CI：1.23-3.13），中位 PFS 差异有统计学意义（4.5 个月，p<0.01）。性别和 RDI 是 OS 和 PFS 的独立预后因素。