Kim Jieun, Yoo Ri Na, Cho Hyeon-Min, Kye Bong-Hyeon, Kim Hyung Jin
Division of Colorectal Surgery, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Division of Colorectal Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Clin Oncol. 2021 Jun;17(1):8-14. doi: 10.14216/kjco.21002. Epub 2021 Jun 30.
Adjuvant chemotherapy is recommended after curative surgery in patients with colon cancer of high-risk stage II and stage III. However, a considerable number of patients cannot complete the scheduled adjuvant treatment for various reasons. This study investigates the hindering factors to the adherence to adjuvant chemotherapy and their impact on long-term survival.
A retrospective study was conducted for patients with colon cancer and had curative resection from 2009 to 2014. Among patients with pathologic stage II and III, stage II with low-risk features, double primary cancers, R2 resection cases were excluded. Patients were grouped into three groups: no-adjuvant therapy, adjuvant therapy for less than 3 months, and more than 3 months. Factors for withdrawal and the oncologic outcome were analyzed.
Of 571 patients, adjuvant chemotherapy was recommended in 403. One hundred and sixteen patients (28.8%) did not receive adjuvant chemotherapy, 78 (19.4%) withdrew within 3 months, and 209 (51.9%) maintained for more than 3 months. Factors for not receiving adjuvant chemotherapy or withdrawing within 3 months were older than 70 and American Society of Anesthesiologists class 3 or higher. Main reasons for discontinuation before 3 months were chemotoxicity and patient's refusal. The long-term oncologic outcome of the patients who received adjuvant chemotherapy for more than 3 months was significantly better than others.
No-adjuvant therapy or receiving them for lesser than 3 months is significantly affected by the patient's performance status and social support, which coincides with a poor oncologic outcome. Social support and rehabilitation system may help to improve the survival outcome.
对于高危II期和III期结肠癌患者，建议在根治性手术后进行辅助化疗。然而，相当多的患者由于各种原因无法完成预定的辅助治疗。本研究调查了辅助化疗依从性的阻碍因素及其对长期生存的影响。
对2009年至2014年接受结肠癌根治性切除的患者进行回顾性研究。在病理II期和III期患者中，排除具有低风险特征的II期、双原发性癌、R2切除病例。患者分为三组：未接受辅助治疗、辅助治疗少于3个月、辅助治疗超过3个月。分析停药因素和肿瘤学结局。
571例患者中，403例被建议进行辅助化疗。116例患者（28.8%）未接受辅助化疗，78例（19.4%）在3个月内停药，209例（51.9%）维持治疗超过3个月。未接受辅助化疗或在3个月内停药的因素为年龄大于70岁和美国麻醉医师协会分级为3级或更高。3个月前停药的主要原因是化疗毒性和患者拒绝。接受辅助化疗超过3个月的患者的长期肿瘤学结局明显优于其他患者。
未接受辅助治疗或接受辅助治疗少于3个月受患者的身体状况和社会支持的显著影响，这与不良的肿瘤学结局相符。社会支持和康复系统可能有助于改善生存结局。
