Adjuvant Chemotherapy for Stage III Colorectal Cancer in Elderly Patients

輔助性化學治療在第三期大腸直腸癌老年病患之分析

盧延榕(Yen-Jung Lu) ； 林春吉(Chun-Chi Lin) ； 王煥昇(Huann-Sheng Wang) ； 楊純豪(Shung-Haur Yang) ； 姜正愷(Jeng-Kai Jiang) ； 藍苑慈(Yuan-Tzu Lan) ； 林資琛(Tzu-Chen Lin) ； 陳維熊(Wei-Shone Chen) ； 林楨國(Jen-Kou Lin) ； 張世慶(Shih-Ching Chang)

《中華民國大腸直腸外科醫學會雜誌》 26卷2期 (2015/06) Pp. 57-63

https://doi.org/10.6312/SCRSTW.2015.26(2).10331

摘要

目的　輔助性化學治療在術後的第三期大腸直腸癌病患已是標準治療。由於化學治療本身有毒性，對老年病患是否有益令人存疑。這項研究評估輔助性化學治療在老年病患的存活效益。方法　從2004年4月至2007年12月，共448位接受過治癒性手術的第三期大腸直腸癌病患。研究的主要目標是無病存活率及整體存活率，並評估病患接受輔助性化學治療期間所發生的副作用，包括嗜中性球低下、血小板低下、貧血及感染事件。結果　共計241位年紀在70歲以下的病患，以及207位年長於70歲的病患。在年輕的病患方面，接受過輔助性化學治療者的五年無病存活率較高（62.1% vs. 33.3%, p=0.095），五年整體存活率明顯較好（77.9% vs. 50.0%, p=0.026）。在年長者這組，接受輔助性化學治療者的五年整體存活率明顯較佳（64.6% vs. 40.9%, p=0.013），但五年無病存活率無顯著差異（55.6% vs. 49.8%, p=0.668）。接受輔助性化學治療的老年病患發生血液學方面副作用，如貧血及嗜中性球低下者的頻率明顯較高。結論　輔助性化學治療在老年大腸直腸癌病患的效益仍有疑義，需要慎選病患。老年病患在血液學方面相關的副作用較高，必須密切監測以避免嚴重副作用。

關鍵字

大腸直腸癌 ； 輔助性化學治療 ； 老年病患

並列摘要

Background. Adjuvant chemotherapy is a standard treatment for stage III colorectal cancer patient under curative surgery. Since the toxicity of chemotherapy, the benefit of chemotherapy has been doubtful for elderly patients. This study evaluates the survival benefit of adjuvant chemotherapy in elderly patients. Methods. Atotal of 448 stage III colorectal cancer patients receiving curative surgery from April 2004 to December 2007 were enrolled. The primary outcome was post-operative disease-free survival (DFS) and overall survival (OS). The toxic effects measured during adjuvant chemotherapy include neutropenia, thrombocytopenia, anemia and infection event. Results. There were 241 patients younger than 70 and 207 patients older than 70. In the younger group, the 5-year disease-free survival (DFS) was slightly higher in the patients with adjuvant chemotherapy (5-year DFS: 62.1% vs. 33.3%, p=0.095), and the 5-year overall survival (OS) was significantly higher (5-year OS: 77.9% vs. 50.0%, p=0.026). However, in the older group, the 5-year OS was significantly higher in the adjuvant chemotherapy group (64.6% vs. 40.9%, p=0.013), but the 5-year DFS showed no difference (55.6% vs. 49.8%, p=0.668). The frequency of hematologic toxicity, such as anemia and neutropenia, was significantly higher in the older patients with intravenous chemotherapy. Conclusion. The effect of adjuvant chemotherapy in elderly patients with colorectal cancer was equivocal. Careful patient selection is necessary. Increased hematologic adverse events were observed in elderly patients with intravenous chemotherapy; close monitoring is necessary to avoid severe adverse events.

並列關鍵字

Colorectal cancer ； Adjuvant chemotherapy ； Elderly patient

參考文獻

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