Department of Radiation Oncology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, 350001, China.
Department of Radiation Oncology, College of Clinical Medicine, Fujian Medical University, Fuzhou, 350001, China.
BMC Cancer. 2022 Jul 18;22(1):789. doi: 10.1186/s12885-022-09855-z.
Distant metastasis has been the main failure pattern for locoregionally advanced rectal cancer (LARC) patients, and intensified neoadjuvant chemotherapy has become a popular research topic. The present study aimed to compare the survival outcomes, acute toxicities and surgical complications in LARC patients who received preoperative chemoradiotherapy with triweekly oxaliplatin and capecitabine (triweekly XELOX) or capecitabine.
Between 2007 and 2017, patients with clinically staged II-III rectal cancer who were treated with preoperative chemoradiotherapy using either triweekly XELOX (oxaliplatin 130 mg/m plus capecitabine 825 mg/m) or capecitabine were included. Variables potentially influencing chemotherapy treatment selection were used to generate propensity scores (PS). The association between chemotherapy regimens and survival endpoints, including distant metastasis-free survival (DMFS), overall survival (OS) and disease-free survival (DFS), were evaluated and adjusted with PS. The acute toxicities and surgical complications were also compared.
A total of 810 patients were included in the analysis; 277 (34.2%) patients received triweekly XELOX, and 533 (65.8%) received capecitabine. The pathological complete response (pCR) rates were 20.2 and 19.9% (P = 0.912) for the groups treated with triweekly XELOX and capecitabine, respectively. The 5-year DMFS, OS and DFS with triweekly XELOX versus capecitabine were 75.6% vs. 77.6% (P = 0.555), 79.2% vs. 83.3% (P = 0.101), and 69.9% vs. 73.7% (P = 0.283), respectively. Triweekly XELOX was not associated with an increased risk of severe toxicity during chemoradiotherapy, but it increased the risk of postoperative complications compared to capecitabine. After PS adjustment, the differences between the two groups remained insignificant in pCR rate, survival outcomes, and acute toxicities, and the difference in surgical complications disappeared.
Triweekly XELOX or capecitabine concurrent with neoadjuvant radiotherapy leads to similar long-term survival outcomes, acute toxicities and surgical complications in LARC patients.
远处转移一直是局部晚期直肠癌（LARC）患者的主要失败模式，强化新辅助化疗已成为一个热门研究课题。本研究旨在比较接受三星期奥沙利铂和卡培他滨（三星期 XELOX）或卡培他滨术前放化疗的 LARC 患者的生存结果、急性毒性和手术并发症。
2007 年至 2017 年间，纳入接受术前放化疗的临床分期 II-III 期直肠癌患者，化疗方案分别为三星期 XELOX（奥沙利铂 130mg/m2 联合卡培他滨 825mg/m2）或卡培他滨。使用潜在影响化疗治疗选择的变量生成倾向评分（PS）。评估并调整 PS 后，比较化疗方案与无远处转移生存（DMFS）、总生存（OS）和无病生存（DFS）等生存终点之间的关联。比较急性毒性和手术并发症。
共纳入 810 例患者，其中 277 例（34.2%）患者接受三星期 XELOX 治疗，533 例（65.8%）患者接受卡培他滨治疗。XELOX 组和卡培他滨组的病理完全缓解（pCR）率分别为 20.2%和 19.9%（P=0.912）。XELOX 组和卡培他滨组的 5 年 DMFS、OS 和 DFS 分别为 75.6%和 77.6%（P=0.555）、79.2%和 83.3%（P=0.101）和 69.9%和 73.7%（P=0.283）。与卡培他滨相比，XELOX 组在放化疗期间严重毒性的风险并未增加，但与卡培他滨相比，术后并发症的风险增加。在 PS 调整后，两组之间的 pCR 率、生存结果和急性毒性差异无统计学意义，手术并发症的差异也消失。
XELOX 三星期或卡培他滨联合新辅助放疗在 LARC 患者中导致相似的长期生存结果、急性毒性和手术并发症。
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