Adjuvant Chemotherapy Has a Limited Benefit in Terms of Recurrence-free Survival and Overall Survival in Colon Cancer with Solitary Lymph Node Metastasis: A Propensity Score Matching Analysis

評估輔助化學治療在單一淋巴結轉移大腸癌病患之存活效益－一個傾向分數配對分析研究

張哲源(Che-Yuan Chang) ； 林宏鑫(Hung-Hsin Lin) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 張世慶(Shih-Ching Chang) ； 王煥昇(Huann-Shenn Wang) ； 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-Kai Jiang)

《中華民國大腸直腸外科醫學會雜誌》 32卷3期 (2021/09) Pp. 150-158

https://doi.org/10.6312/SCRSTW.202109_32(3).11012

摘要

Background. Although current guidelines support adjuvant chemotherapy for stage III colon cancer, its therapeutic effects have not been proven in colon cancers with solitary node metastasis (SLNM). This study focuses on recurrence free survival (RFS) and overall survival (OS) in colon cancer with SLNM with or without adjuvant chemotherapy. Methods. We retrospectively studied 273 patients who had colon cancer with SLNM who received curative resection between 2004 and 2015. Clinicopathological factors, RFS and OS were compared between those who underwent adjuvant chemotherapy and those who did not. A propensity score match (PSM) of ratio 1:1 propensity score match was then used to diminish the selection bias between the groups. Results. The adjutant chemotherapy and non-adjuvant chemotherapy groups represented 78.7 and 21.3% of the sample size, respectively. The non-chemotherapy group were of a older age, had more comorbidities, and poorer performance status (all at p ＜ 0.001) as well as had a higher rate of tumor obstruction or perforation (p = 0.002). Before PSM, RFS did not significantly differ between the groups whereas OS was significantly higher in the adjuvant chemotherapy group (p ＜ 0.001). Moreover, after PSM, both RFS (p = 0.591) and OS (p = 0.992) did not significantly differ between the groups. Conclusions. The survival benefit of adjuvant chemotherapy was limited in colon cancer with SLNM after propensity score matching.

關鍵字

Adjuvant chemotherapy ； Stage III colon cancer ； Solitary lymph node metastasis ； Survival analysis ； Propensity score matching

並列摘要

前言：目前第三期大腸癌術後皆建議施行輔助性化學治療，但化學治療實際效益在單一淋巴結轉移大腸癌病患中尚未明瞭。本研究探討並比較化學治療與否對單一淋巴結轉移大腸癌病患在無復發存活與總體存活之差異。材料與方法：本研究回顧單一醫學中心2004至2015年病例，統計273名單一淋巴結轉移大腸癌病患之臨床與病理因子，並根據化學治療與否比較無復發存活與總體存活率差異。為消除化學治療與否組間選樣偏差，研究使用1:1傾向分數配對（propensity score matching）比較存活差異。結果：273名病患中接受與未接受化學治療病例分別佔總樣本數之78.7%與21.3%。未接受化學治療病例平均年齡較長、體能狀態（performance status）較差、美國麻醉醫學會分級（ASA score）較高（p值皆＜ 0.001）與術前出現腫瘤阻塞或破裂比例較高（p = 0.002）。在傾向分數配對前之無復發存活曲線與接受輔助化學治療與否無統計顯著性但接受化學治療病例總體存活曲線顯著優於未接受化學治療病例（p值＜ 0.001）。傾向分數配對後接受化學治療與否對於無復發存活（p = 0.591）與總體存活曲線（p = 0.992）皆無顯著性影響。結論：本研究顯示輔助性化學治療對於單一淋巴結轉移大腸癌病例在無復發存活與總體存活率改善之侷限。

並列關鍵字

輔助化學治療 ； 第三期大腸癌 ； 單一淋巴結轉移 ； 存活分析 ； 傾向分數配對

參考文獻

Weiser MR. AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol. 2018;25(6):1454-5.

Kim HS, Kim KM, Lee SB, Kim GR, Han YD, Cho MS, et al. Clinicopathological and biomolecular characteristics of stage IIB/IIC and stage IIIA colon cancer: Insight into the survival paradox. J Surg Oncol. 2019;120(3):423-30.

Chu QD, Zhou M, Medeiros KL, Peddi P, Kavanaugh M, Wu XC. Poor survival in stage IIB/C (T4N0) compared to stage IIIA (T1-2 N1, T1N2a) colon cancer persists even after adjusting for adequate lymph nodes retrieved and receipt of adjuvant chemotherapy. BMC Cancer. 2016;16:460.

André T, de Gramont A, Vernerey D, Chibaudel B, Bonnetain F, Tijeras-Raballand A, et al. Adjuvant Fluorouracil, Leucovorin, and Oxaliplatin in Stage II to III Colon Cancer: Updated 10-Year Survival and Outcomes According to BRAF Mutation and Mismatch Repair Status of the MOSAIC Study. J Clin Oncol. 2015;33(35):4176-87.

Li Q, Wang Y, Cai G, Li D, Cai S. Solitary lymph node metastasis is a distinct subset of colon cancer associated with good survival: a retrospective study of surveillance, epidemiology, and end-results population-based data. BMC Cancer. 2014;14:368.