- 期刊
Is the Tegafur/uracil and Leucovorin Adjuvant Chemotherapy Overused in Low-risk Group Stage II Colorectal Cancer Patients?
使用輔助性口服化療藥物於低風險第二期大腸直腸癌病人是否有過度使用的情形？
摘要
目標近年來大腸直腸癌是國內癌症發生率第一名、死亡率第三名的疾病。因為全國性的糞便潛血試驗檢查，有越來越多大腸直腸癌患者於早期被診斷發現。根據NCCN guideline的建議，術後的輔助性化學治療可用於高風險第二期大腸直腸癌的患者。但是輔助性化療對於低風險第二期大腸直腸癌的研究卻不多，我們希望可以藉由本院的資料庫進行輔助性口服化療藥物對於低風險第二期大腸直腸癌治療的成效評估。方法我們統計了從2004年6月到2009年8月共1273位在林口長庚紀念醫院、基隆長庚紀念醫院接受根治性手術治療的第二期大腸直腸癌患的資料，排除了六個月內復發以及接受靜脈注射化學治療的病人後，共記錄了1107位病人完整的臨床及病理特徵進行分析。其中515位病人屬於低風險第二期大腸直腸癌患者進行近一步的研究分析。結果在我們的資料庫中，屬於高風險第二期大腸直腸癌的患者有較差的總生存率及較差的5年無病生存率。低風險第二期大腸直腸癌的這組病人中，共有70名患者接受術後的輔助性口服化療藥物治療而445名病人未接受治療。經過分析後發現，接受輔助性口服化療藥物治療的低風險第二期大腸直腸癌的患者在總生存率及5年無病生存率上並無顯著的差異。結論我們的研究顯示，對於低風險第二期大腸直腸癌的患者而言，輔助性口服化療藥物屬於過度的治療，並無法延長病人的壽命以及五年無病生存率。相對之下，我們應該避免低風險第二期大腸直腸癌的患者暴露於不必要的化學治療風險中以及經濟效益。
並列摘要
Purpose. Colorectal cancer is one of the most common cancers and the third leading cause of cancer-related death in Taiwan. Because of the nationwide biennial fecal immunochemical screening, the number of colorectal cancer cases detected at an early stage is increasing. According to the National comprehensive cancer network (NCCN) clinical practice guidelines, adjuvant chemotherapy is suggested for patients with high-risk group stage II colorectal cancer; research in the low-risk group stage II colorectal cancer has been less specific. We aimed to review our hospital database to evaluate the effect of uracil-tegafur (UFT) and leucovorin adjuvant chemotherapy on low-risk group stage II colorectal cancer patients. Materials and Methods. Between January 2004 and August 2009, 1273 stage II colorectal cancer patients underwent standard curative operations at the Linkou and Keelung Branch of Chang Gung Memorial Hospital in Taiwan. After excluding the patients with early recurrence within 6 months after the operation, and those who received intravenous adjuvant chemotherapy, the remaining 1107 patients were enrolled in the study. After analyzing the pathological and clinical characteristics of the patients, 515 were identified to have low-risk group stage II colorectal cancer. All patients in this group were followed up for at least 5 years postoperatively or until the date of patient death. Statistical analysis was performed with SPSS ver. 20. Results. In our database, patients in the high-risk group (n = 592) had significantly worse overall survival and 5-year disease-free survival compared to those in the low-risk group (n = 515). In the low-risk group stage II colorectal cancer patients, 70 patients received UFT and leucovorin adjuvant chemotherapy, while 445 patients did not receive adjuvant chemotherapy. Comparing the two groups revealed that UFT and leucovorin adjuvant chemotherapy did not improve the overall survival or 5-year disease- free survival in the low-risk group stage II colorectal cancer patients. Conclusion. Our data showed that low-risk group stage II colorectal cancer patients who received the UFT and leucovorin adjuvant chemotherapy might be overtreated. We should aim to avoid exposing these patients to the side effects of unnecessarily administered chemotherapy, and control its impact on the economy.