Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222 Maijin Rd., Anle Dist., Keelung City, 20401, Taiwan.
Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.
BMC Cancer. 2023 Sep 25;23(1):900. doi: 10.1186/s12885-023-11310-6.
Early-stage colorectal cancer had excellent outcomes after curative resection, typically. However, a perplexing survival paradox between stage II and stage III was noted. This paradox could be influenced by the administration of routine postoperative adjuvant chemotherapy and the presence of high-risk factors in stage II CRC. The objective of the study was to investigate the influence of high-risk factors on patients with stage II CRC and assess the efficacy of oral tegafur/uracil (UFT) plus leucovorin as adjuvant chemotherapy for stage II CRC patients.
A retrospective study was conducted using propensity score matching at a single medical institution. A total of 1544 patients with stage II colorectal cancer who underwent radical surgery between January 2004 and January 2009 were included. The intervention used was tegafur/uracil plus leucovorin as adjuvant chemotherapy. The main outcome measures were disease-free survival and overall survival.
After propensity score matching, 261 patients were included in three groups: no-treatment, half-year treatment, and one-year treatment. The clinical characteristics of each group tended to be more consistent. The Cox proportional hazard models showed that tegafur/uracil treatment or not was a significant independent factor for oncological outcome. Kaplan-Meier analysis also showed significantly better disease-free survival and overall survival. Further investigation revealed that tegafur/uracil duration was an independent factor for oncological outcome. While the survival curve did not reach statistical significance, the one-year UFT treatment group demonstrated the best treatment trend.
This study suggests that tegafur/uracil plus leucovorin is a feasible adjuvant chemotherapy regimen for patients with stage II colorectal cancer after curative surgical treatment. Prolonged tegafur/uracil plus leucovorin treatment for 12 months showed a trend towards better outcomes in patients with stage II colorectal cancer.
早期结直肠癌经根治性切除后通常具有良好的预后。然而，在 II 期和 III 期之间观察到了令人费解的生存悖论。这种悖论可能受到 II 期 CRC 中常规术后辅助化疗和高危因素的影响。本研究的目的是探讨高危因素对 II 期 CRC 患者的影响，并评估替加氟/尿嘧啶（UFT）联合亚叶酸钙作为 II 期 CRC 患者辅助化疗的疗效。
采用单中心回顾性研究，采用倾向评分匹配法。共纳入 2004 年 1 月至 2009 年 1 月期间接受根治性手术治疗的 1544 例 II 期结直肠癌患者。干预措施为替加氟/尿嘧啶联合亚叶酸钙作为辅助化疗。主要观察终点为无病生存期和总生存期。
经倾向评分匹配后，共有 261 例患者被分为三组：未治疗组、半年治疗组和一年治疗组。每组的临床特征趋于更加一致。Cox 比例风险模型显示，替加氟/尿嘧啶治疗与否是影响肿瘤学结果的显著独立因素。Kaplan-Meier 分析也显示无病生存期和总生存期明显更好。进一步研究表明，替加氟/尿嘧啶的持续时间是肿瘤学结果的独立因素。虽然生存曲线未达到统计学意义，但 UFT 治疗 1 年组显示出最佳的治疗趋势。
本研究表明，替加氟/尿嘧啶联合亚叶酸钙是结直肠癌根治术后 II 期患者可行的辅助化疗方案。替加氟/尿嘧啶联合亚叶酸钙延长 12 个月治疗对 II 期结直肠癌患者的结局有更好的趋势。
