Use of Adjuvant Chemotherapy for Extremely Elderly Patients with Stage III Colorectal Cancer

術後化學治療於第三期結腸直腸癌之極老年患者的分析

林艿律(Nai-Lu Lin) ； 陳周斌(Joe-Bin Chen) ； 王煥昇(Huann-Sheng Wang) ； 張世慶(Shih-Ching Chang) ； 楊純豪(Shung-Haur Yang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 姜正愷(Jeng-Kae Jiang)

《中華民國大腸直腸外科醫學會雜誌》 30卷2期 (2019/06) Pp. 77-83

https://doi.org/10.6312/SCRSTW.201906_30(2).10802

摘要

Purpose. Although tumor resection surgery followed by adjuvant chemotherapy is the primary treatment for stage III colorectal cancer, the optimal protocol for patients aged ≥80 years remains unclear. Our study aimed to evaluate the long-term outcomes of adjuvant chemotherapy after tumor resection surgery in extremely elderly patients. Methods. We retrospectively examined patients aged ≥80 years, who were diagnosed with stage III colorectal cancer following tumor resection surgery between 2009 and 2013 at the Taipei and Taichung Veterans General Hospital. Normally distributed data are presented as mean and assessed using Chi-square tests. We calculated 5-year overall survival by using the log-rank test. Multivariable proportional hazards regression analysis was used to determine independent risk factors for overall mortality. Results. In total, 213 patients were analyzed and divided into two groups: complete (n = 71) or incomplete adjuvant chemotherapy (n = 142). The group of complete adjuvant chemotherapy had better 5-year overall survival (52.4% vs. 35.2%, p = 0.003). The timing of initial adjuvant chemotherapy after surgery was 6.86 weeks in average. Multivariate analysis showed that the independent prognostic factors were TNM stage and the receiving of complete adjuvant chemotherapy, or not (p = 0.006; p = 0.001). Conclusion. Nearly half of the extremely elderly patients with stage III colorectal cancer didn't complete adjuvant chemotherapy. Those who received complete adjuvant chemotherapy showed higher overall survival in our study.

關鍵字

Extremely elderly patient ； Colorectal cancer ； Adjuvant chemotherapy

並列摘要

第三期結腸直腸癌的治療方法目前以腫瘤切除手術合併術後化學治療為主，但對於年齡大於八十歲患者的最佳治療方法仍未確定。本研究旨在評估術後化學治療對於接受腫瘤切除手術後確診為第三期結腸直腸癌患者的療效。這項回顧性研究收錄2009年至2013年間在台北榮民總醫院及台中榮民總醫院接受結腸直腸癌腫瘤切除手術的老年患者。正態分佈數據以平均值表示，並用chi-square檢驗進行檢驗。兩組病患五年存活率以log-rank test表示，死亡率相關因子也進行多變相分析。共收錄222名老年患者，排除9位發生術後一個月內死亡病患，其餘病患分為完成術後化療，及未接受或未完成術後化療兩組，分別有71位及142位。研究顯示完成術後化學治療病患有較高的整體存活率（52.4% vs. 35.2%，p＝0.003）。病患平均於術後6.86周開始接受化學治療。多變項分析顯示TNM分期及是否完成術後化療為獨立預測因子（p＝0.006；p＝0.001）。將近一半的八十歲以上第三期大腸直腸癌患者無法完成術後化療療程。完成化療療程在八十歲以上病患可見較高整體存活率。

並列關鍵字

老年人 ； 結腸直腸癌 ； 術後化學治療

參考文獻

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