- 期刊
Difference between Complete Oxaliplatin Based Adjuvant Chemotherapy and Incomplete Course in Stage III Colorectal Cancer Patients in Taiwan
台灣地區完整的輔助性化學治療與不完整的輔助性化學治療對於第三期大腸直腸癌復發率及存活率的差別
摘要
目的 我們分析第三期大腸直腸癌病患接受不完整的輔助性化學治療 (FOLFOX)。追蹤這些病人的存活率復發率病人及方法 這個case control study 回顧式的分析台中榮民總醫院自2005 年1 月到2012年12 月第三期大腸直腸癌接受手術後輔助性化學治療的病患，根據化學治療療程完成與否區分兩個族群，比較這兩組病患的存活率復發率。結果 平均追蹤34.6 月與35.2 月，未完成化學治療與完成的兩年DFS 分別是86.7% vs82.1% (Hazard ratio: [HR] = 0.70, 95% CI, 0.38 to 1.30, p = 0.254)。未完成化學治療與完成的五年存活率分別是77.2% and 79.0% (Hazard ratio: [HR] = 1.37, 95% CI, 0.69 to 2.78, p= 0.366)。復發率與存活率在統計學上沒有意義，但未完整的療程在DFS 有比較好的趨勢，49% 病人不能完成12 次完整的化療，在不能完成化療的病人之中最常見的副作用是腸胃道症狀及神經感覺異常，復發型態在兩組沒有明顯差異。再進一步分析stage 3A +3B 與3C 病人中，stage 3A + 3B 病患未完成化療的病患也有相當的存活率復發率，但stage3C 病患有完成化療的整體預後較佳。結論 對第三期大腸直腸癌患者來說未完全的療程與完全的療程在DFS 與OS 上沒有誰比較好的顯著意義，但未完全的療程在DFS 曲線反而可看到較好的趨勢，對於第三期大腸癌病患，即使無法完成化療，也不會有較差的復發率，但stage 3C 患者，有完成12次FOLFOX 療程的還是有較好的預後，還是建議儘量完成。
並列摘要
Purpose. We have analyzed stage III colorectal patients who cannot receive complete course oxaliplatin based adjuvant chemotherapy (FOLFOX). We have followed up this group of patients, and have gained information for the patients who cannot complete adjuvant chemotherapy in the aspect of overall survival and recurrence rate. Patients and Methods. This was a case control study. We retrospectively analyzed stage III colorectal cancer patients who received adjuvant chemotherapy at Taichung Veteran General Hospital (VGHTC) from Jan. 2005 to Dec. 2012. The patients were enrolled and classified according to the duration of chemotherapy. Consequence of disease free survival (DFS), overall survival (OS) will be analyzed. Result. Two-year disease free survival (DFS) rates were 86.7% and 82.1% in patients’ receiving incomplete course FOLFOX and complete course FOLFOX respectively (Hazard ratio: [HR] = 0.70, 95% CI, 0.38 to 1.30, p = 0.254). Five-year overall survival rates (OS) were 77.2% and 79.0% in patients’ receiving incomplete course FOLFOX and complete course FOLFOX respectively (Hazard ratio: [HR] = 1.37, 95% CI, 0.69 to 2.78, p = 0.366). 49% patients cannot complete full-course adjuvant chemotherapy FOLFOX. The most frequent reasons of incomplete chemotherapy were severe gastrointestinal side effect and sensory neuropathy. The recurrent pattern were liver, lung metastasis, and peritoneum seeding in both groups. In the stage of 3A + 3B incomplete group, non-inferior trend in DFS and OS was noted. In the stage of 3C complete course group, superior trend in overall survival was noted. Conclusion. For stage III colorectal cancer adjuvant chemotherapy setting, incomplete course FOLFOX didn’t get worse in overall survival. There was also a leading trend toward complete course in DFS. But in the stage of 3C colorectal cancer patients, complete course FOLFOX was an indicator for better OS. The result was pending further larger randomized clinical trial.
參考文獻
延伸閱讀
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