The Effectiveness of the Tegafur/uracil and Leucovorin Adjuvant Chemotherapy for Stage II Colorectal Cancer Patients Based on the Tumor Location

輔助性口服化療藥物對於第二期大腸直腸癌病人治療的成效之以腫瘤位置為基礎

張書豪(Shu-Hao Chang) ； 范仲維(Chung-Wei Fan) ； 曾文科(Wen-Ko Tseng) ； 游彥麟(Yen-Lin Yu)

《中華民國大腸直腸外科醫學會雜誌》 31卷3期 (2020/09) Pp. 149-158

https://doi.org/10.6312/SCRSTW.202009_31(3).10903

摘要

Introduction. Colorectal cancer is one of the most common cancers and the third leading cause of cancer-related death in Taiwan. Colorectal cancer can be characterized by the tumor location with proximal or right-sided colon cancer and distal or left-sided colorectal cancer. The distinction between the tumor locations is important because they have different clinical responses to chemotherapy. In this study, we compared the effectiveness of uracil-tegafur (UFT) as the adjuvant chemotherapy in stage II colorectal cancer between different tumor locations and variable risk levels. Materials and Methods. The participants involved were 1320 stage II colorectal cancer patients who underwent standard curative operations at the Keelung and Linkou Branch of Chang Gung Memorial Hospital between January 2004 and August 2009. After excluding patients who received radiotherapy, surgical mortality during the same hospitalization, patients with early recurrence within 6 months, and those who received intravenous chemotherapy, the remaining 1149 patients were enrolled in the study. After analyzing the medical records, 363 patients were classified as right-sided colon cancer (31.6%) patients and 786 patients were classified as left-sided colorectal cancer (68.4%) patients depending on whether their location was proximal to the splenic flexure or not. All patients were followed up for at least 5 years postoperatively or until the death of the patient. Statistical analysis was performed with SPSS ver. 20. Results. In our database, the right-sided colon cancer patients had higher proportion of females, poor differentiation, anemia, poor nutrition status, were a high-risk group, and constituted the UFT treatment group. The adjuvant chemotherapy for high-risk stage II colorectal cancer can improve the 5-year disease free survival and overall survival whether it be a right-sided colon cancer or a left-sided colorectal cancer. For low-risk stage II colorectal cancer patients, the UFT treatment can improved the overall survival in left-side colorectal cancer patients (with UFT vs. without UFT: 93.8% vs. 81.8%, log-rank p = 0.038). Conclusion. Our data showed that UFT treatment had benefits in both high-risk stage II right-sided and left-sided colorectal cancer although they have different molecular pathways of carcinogenesis. Further, the low-risk stage II left-sided colorectal cancer patients had better outcomes from the UFT treatment.

關鍵字

Right-sided colon cancer (RCC) ； Left-sided colorectal cancer (LCRC) ； High-risk/low-risk stage II colorectal cancer ； Tegafur/uracil (UFT) adjuvant chemotherapy

並列摘要

目的：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。大腸直腸癌可以依照腫瘤所在的位置分成近端／右側大腸癌以及遠端／左側大腸直腸癌。而腫瘤的不同位置對化學治療在臨床上有著不同的反應。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不同腫瘤位置、不同風險的第二期大腸直腸癌治療成效進行評估。方法：我們統計了從2004年6月到2009年8月共1320位在基隆長庚紀念醫院、林口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資料，排除了接受放射線治療、術後死亡個案、六個月內復發以及接受靜脈注射化學治療的病患後，共分析了1149位病患完整的臨床病歷。其中363位病患屬於右側第二期大腸癌患者（36.1%），786位病患屬於左側第二期大腸直腸癌患者（68.4%），再進行近一步的研究分析。結果：在我們的資料庫中，右側大腸癌的患者相較於左側大腸直腸癌的患者女性的比例較高；病理學上分化不良的比例較高；貧血、營養不良的比例較高；屬於高風險第二期大腸直腸癌及接受輔助性口服化療藥物治療的比例也較高。無論腫瘤是位在右側結腸還是左側結腸直腸，輔助性口服化療藥物都可改善高風險第二期大腸直腸癌的5年無病生存率及總體生存率。對於低風險第二期的大腸直腸癌患者而言，輔助性口服化療藥物的治療可以改善左側結直腸癌患者的總體生存率。結論：我們的研究顯示，優富多的治療可以改善高風險左右側大腸直腸癌患者的5年無病生存率和總體生存率。右側大腸癌和左側大腸直腸癌具有不同的分子生成途徑和對化療反應。在低風險的第二期大腸直腸癌患者中，由於不同的腫瘤位置，優富多的治療似乎對左側大腸直腸癌有更好的效果。

並列關鍵字

右側大腸癌 ； 左側大腸直腸癌 ； 高／低風險第二期大腸直腸癌 ； 優富多 ； 輔助性化療

參考文獻

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