Prognostic Value of the Cycle Number of Perioperative Chemotherapy in Locoregionally Advanced Rectal Cancer: a Propensity Score Matching Analysis
Prognostic Value of the Cycle Number of Perioperative Chemotherapy in Locoregionally Advanced Rectal Cancer: a Propensity Score Matching Analysis
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DOI：
10.7150/jca.27251
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发表时间：
2018-01-01
影响因子：
3.9
通讯作者：
Gao, Yuan-hong
中科院分区：
文献类型：
--
作者：
Chang, Hui;Yu, Xin;Gao, Yuan-hong
背景：局部进展期直肠癌（LARC）患者围手术期化疗的合适周期数仍不清楚。本研究旨在评估围手术期化疗的周期数如何影响LARC patients.Methodology / Principal Findings的预后：在这项研究中，共有388例连续患者入选并回顾性分析，如果他们被诊断为未经治疗的cII-III期LARC，并接受新辅助放化疗加根治性手术，然后辅助化疗或不。按术后病理分期（yp 0-I与ypII-III）分组后，对各组进行倾向评分匹配，以平衡接受化疗周期= 8的患者之间的基线特征。分析化疗周期与两组患者生存率的关系。并比较两组治疗相关并发症的发生率。通过分析，化疗周期>= 8似乎预测了整个匹配患者队列（P值分别为0.003、0.002和0.004）和ypII-III组（P值分别为0.006、0.005和0.014）的总体、无疾病和无远处转移生存率。而yp 0-Ⅰ组化疗周期≥ 8个时，生存率无明显提高，但急性毒性反应发生率明显增加（83.5%vs.57.0%，P < 0.001）。但对于yp 0-I期患者应慎用延长化疗时间。
Background: Appropriate cycle number of perioperative chemotherapy for patients with locoregionally advanced rectal cancer (LARC) remains unknown. This study aimed to evaluate how cycle number of perioperative chemotherapy influenced the prognosis of LARC patients.Methodology / Principal Findings: In this study, a total of 388 consecutive patients were enrolled and retrospectively reviewed if they were diagnosed with untreated stage cII-III LARC and treated with neoadjuvant chemoradiotherapy plus radical surgery followed by adjuvant chemotherapy or not. After grouping by the postoperative pathologic stage (yp0-I vs. ypII-III), propensity score matching was performed in each group to balance baseline characteristics between the patients treated with chemotherapy cycle = 8. The chemotherapy cycle was analyzed for its association with the survivals of the matched patients in the 2 groups, respectively. And the incidence of treatment-related complications was also compared. Through analysis, chemotherapy cycle >= 8 appeared to predict better overall, disease-free and distant-metastasis-free survivals in the whole cohort of matched patients (P values were 0.003, 0.002 and 0.004, respectively) and the ypII-III group (P values were 0.006, 0.005 and 0.014, respectively). But in the yp0-I group, chemotherapy of 8 cycles or more brought no improvement of survivals but only more acute toxicities (83.5% vs. 57.0%, P < 0.001).Conclusions / Significance: Chemotherapy cycle >= 8 was proven associated with improved prognosis of LARC patients, especially those with ypII-III disease. But prolonged chemotherapy should be performed with caution in patients with yp0-I stage.