Survival Rate between Intravenous Adjuvant Chemotherapy in Inpatient and Outpatient Department Settings for Patients with Stage III Colorectal Cancer

第三期大腸直腸癌病人接受門診及住院術後輔助性化學治療的存活率間的比較

陳映菁(Ying-Jing Chen) ； 陳明正(Ming-Cheng Chen) ； 陳周斌(Joe-Bin Chen) ； 蔣鋒帆(Feng-Fan Chiang) ； 陳周誠(Chou-Chen Chen)

《中華民國大腸直腸外科醫學會雜誌》 32卷4期 (2021/12) Pp. 174-181

https://doi.org/10.6312/SCRSTW.202112_32(4).11017

摘要

Purpose. Adjuvant chemotherapy with oxaliplatin plus fluoropyrimidine for 6 months has become the standard treatment for stage III colorectal cancers since 2004. Some patients receive intravenous chemotherapy at the inpatient department (IPD) rather than the outpatient department (OPD) because of several reasons, such as commercial health insurance, severe side effects or relatively poor general conditions. In addition, the limited availability of beds causes delayed admissions for those patients who received inpatient chemotherapy. This retrospective study aimed to evaluate the effects of delayed admissions for adjuvant chemotherapy on oncologic results. Methods. Patients with stage III colorectal cancer who had received more than 6 cycles of intravenous chemotherapy of FOLFOX or XELOX from January 2010 to December 2014 at Taichung Veterans General Hospital, Taichung, Taiwan were enrolled in this retrospective study. We utilized IBM SPSS ver. 22.0 as the statistical software to run our analysis. The Kaplan-Meier method was used to analyze the disease-free survival (DFS) and overall survival (OS) rates. Statistical results were considered significant when the p-value was less than 0.05. Results. A total of 257 patients were enrolled. Among them, 211 patients were in the OPD group, and 46 patients were in the IPD group. The age between these groups showed a statistically significant difference, and the median age of OPD: IPD was 58 [51-67]: 53 [46-66] (p = 0.024). There is no statistical difference in gender, co-morbidities, ECOG PS score, location of tumor, adverse effects, time to initiate chemotherapy and the number of cycles between the 2 groups. Meanwhile, the median duration of chemotherapy (months) and the standardized median duration of chemotherapy were significantly longer for the IPD group than the OPD group (5.75 months [5.32-6.21] vs. 6.44 months [5.75-7.85], p ＜ 0.001 and 5.98 months [5.52-6.67] vs. 7.15 months [6.21-8.15], p ＜ 0.001). No significant difference in 3-year DFS rate (71.3% vs. 65.7%), 5-year DFS rate (63.1% vs. 58.9%) (p = 0.697), and 5-year OS rate (80.7% vs. 84.3%, p = 0.306) was found between the OPD and IPD groups. Conclusion. The treatment duration showed a significant difference between the OPD and IPD groups. However, no statistically significant difference in 3-year/5-year DFS and 5-year OS was found between the two groups. Therefore, even though patients with IPD would have to prolong the interval of the entire treatment, the outcome is non-inferior to that of the OPD group.

關鍵字

Colorectal cancer ； Stage III ； Intravenous chemotherapy ； Out-patient department ； In-patient department ； FOLFOX ； XELOX

並列摘要

目的：為期六個月的術後輔助性化學治療oxaliplatin加fluoropyrimidine，在西元2004年起就已經是第三期大腸直腸癌的標準治療。因為許多不同的因素，例如商業醫療保險，有些病人更傾向於接受住院化療而不是門診化療。但由於床位有限，住院病人必須延遲接受化學治療的狀況很常見。為了要釐清接受術後輔助性化療的病人是不會因為延遲入院治療而影響到癌症治療的結果，我們做了這個回顧性研究。方法：此篇回顧性研究蒐集了在2010年1月到2014年12月之間被診斷第三期大腸直腸癌的病人，並在台中榮民總醫院接受超過六次的靜脈注射化療FOLFOX或XELOX。統計軟體為SPSS第22版，我們用Kaplan-Meier方法來分析無病存活率及整體存活率。統計結果若p值小於0.05即為統計學上有意義。結果：總共有257個病人被收案，其中門診組有211位病人，住院組有46位病人。年齡在門診及住院這兩組比較有統計學上的差異，門診病人診斷年齡中位數為58歲，住院病人診斷年齡中位數為53歲，p值為0.024。兩組在性別、共病症、ECOG分數、腫瘤位置、化療副作用、第一次化療開始的時間以及化療次數都沒有統計學上的差異。化療次數中位數兩組皆為12，p值為0.932。與此同時，住院組在化療時間（月）中位數及標準化化療時間（月）的中位都明顯時間較長且有統計學上的意義。門診及住院的化療時間（月）分別為5.75比6.44個月，而標準化化療時間（月）中位數則為5.98比7.15個月，兩者p值皆＜0.001，顯示有統計學上的差異。三年無疾病存活率為71.3%（門診）比65.7%（住院），五年無疾病存活率為63.1%比58.9%，p值為0.679，及五年整體存活率80.7%比84.3%，p值為0.306，兩者皆無統計學上的差異。結論：門診及住院化療病人化療時間是有統計學上的差異的，但兩者之間的3年、5年無疾病存活率及5年整體存活率是沒有統計學上的差異的。所以即使住院病人化療時間比較長，治療結果也沒有比較差。

並列關鍵字

大腸直腸癌 ； 第三期 ； 靜脈注射化學治療 ； 門診 ； 住院 ； FOLFOX ； XELOX

參考文獻

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