Adjuvant chemotherapy is associated with improved survival in patients with stage II colon cancer.
Adjuvant chemotherapy is associated with improved survival in patients with stage II colon cancer.
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DOI：
10.1002/cncr.30181
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发表时间：
2016-11-15
期刊：
影响因子：
6.2
通讯作者：
Maker, Ajay V.
中科院分区：
文献类型：
--
作者：
Casadaban, Leigh;Rauscher, Garth;Aklilu, Mebea;Villenes, Dana;Freels, Sally;Maker, Ajay V.
辅助化疗在II期结肠癌患者中的作用仍有待阐明，其使用因患者和机构而异。目前，临床指南建议在缺乏结论性随机对照试验数据的情况下，对高风险II期疾病患者讨论辅助化疗。为了进一步研究这种关系，本研究旨在确定按年龄和病理危险特征分层的患者的总生存期（OS）与辅助化疗之间是否存在关联。来自国家癌症数据库（NCDB）的数据分析了1998-2006年诊断的II期结肠癌患者的人口统计学、肿瘤特征、管理和生存率，以及2011年的生存信息。使用皮尔逊卡方检验和二元逻辑回归分析疾病和人口统计数据。生存率分析采用Log-rank检验和Cox比例风险回归模型。使用倾向得分加权来匹配队列。在153,110例II期结肠癌患者中，接受化疗的预测因素包括年龄<65岁、男性、非高加索人种、社区治疗设施、非医疗保险和2004年之前的诊断。改善和临床相关的总生存率与所有患者亚组接受辅助化疗相关，无论高危肿瘤病理特征（不良或未分化的组织学，<12淋巴结评估，阳性边缘或T4组织学），年龄或化疗方案，甚至在调整协变量和倾向评分加权后（HR 0.76, p<0.001）。单药和多药辅助化疗方案的生存率没有差异。在迄今为止评估的最大的II期结肠癌患者组中，无论治疗方案、患者年龄或高危病理风险特征如何，改善的OS与辅助化疗相关。
The role of adjuvant chemotherapy in patients with stage II colon cancer remains to be elucidated and its use varies between patients and institutions. Currently, clinical guidelines suggest discussing adjuvant chemotherapy for patients with high-risk stage II disease in the absence of conclusive randomized controlled trial data. In order to further investigate this relationship, the study aimed to determine whether an association exists between overall survival (OS) and adjuvant chemotherapy in patients stratified by age and pathological-risk features. Data from the National Cancer Data Base (NCDB) was analyzed for demographics, tumor characteristics, management, and survival of patients with stage II colon cancer diagnosed from 1998-2006 with survival information through 2011. Pearson Chi-squared tests and binary logistic regression were used to analyze disease and demographic data. Survival analysis was performed with the Log-rank test and Cox proportional hazards regression modeling. Propensity score weighting was utilized to match cohorts. In 153,110 stage II colon cancer patients, predictors of receiving chemotherapy included age <65, male gender, non-Caucasian race, community treatment facility, non-Medicare insurance, and diagnosis before 2004. Improved and clinically relevant overall survival was associated with the receipt of adjuvant chemotherapy in all patient sub-groups regardless of high-risk tumor pathologic features (poor or undifferentiated histology, <12 lymph nodes evaluated, positive margins, or T4 histology), age, or chemotherapy regimen, even after adjustment for covariates and propensity score weighting (HR 0.76, p<0.001). There was not a difference in survival between single and multi-agent adjuvant chemotherapy regimens. In the largest group of stage II colon cancer patients evaluated to date, improved OS was associated with adjuvant chemotherapy regardless of treatment regimen, patient age, or high-risk pathologic risk features.
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