Right- and left-sided stage III colon cancers present different prognostic outcomes of oxaliplatin-based adjuvant chemotherapy after curative resection.
Right- and left-sided stage III colon cancers present different prognostic outcomes of oxaliplatin-based adjuvant chemotherapy after curative resection.
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DOI：
10.2147/cmar.s163520
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发表时间：
2018
影响因子：
3.3
通讯作者：
Zhang R
中科院分区：
文献类型：
--
作者：
Peng J;Li C;Wang F;Zhang H;Xiao W;Li H;Lu Z;Pan Z;Wu X;Zhang R
越来越多的证据表明，右半结肠癌（RCC）和左半结肠癌（LCC）应被视为不同的肿瘤实体。然而，III期结肠癌目前被视为具有统一疗法的相同实体。本研究的目的是调查肿瘤位置对III期结肠癌根治性切除术后接受辅助化疗的患者预后的影响。我们回顾性分析了2007年12月至2013年12月期间接受根治性肿瘤切除术后接受奥沙利铂和卡培他滨辅助化疗的274例符合条件的III期结肠癌患者。采用Kaplan-Meier和log-rank检验分析无病生存期（DFS）和总生存期（OS），采用考克斯回归分析影响预后的因素。与LCC相比，RCC患者的血红蛋白水平较低（23.6% vs. 9.8%; P = 0.002），肿瘤较大（60.6% vs. 40.9%; P = 0.001），切除12个或更多淋巴结的比例较高（86.4% vs. 64.6%; P < 0.001）。1级神经毒性在RCC患者中比LCC患者更常见（53.6% vs. 40.9%; P = 0.037）。与LCC相比，RCC与较短的3年OS显著相关，而仅在IIIC期而不是IIIA期或IIIB期结肠癌中观察到差异。多变量分析显示，肾细胞癌与3年OS恶化独立相关（风险比：2.213; 95%CI：1.063-4.606; P = 0.002）。此外，仅在RCC患者中观察到6-8个周期的辅助化疗后3年OS和DFS增加，而在LCC患者中未观察到。本研究提示，RCC对III期结肠癌预后较差，建议RCC患者进行全程辅助化疗。
Growing evidence has suggested that right-sided colon cancer (RCC) and left-sided colon cancer (LCC) should be considered as different tumor entities. However, stage III colon cancer is currently treated as the same entity with uniform therapy. This study was aimed at investigating the prognostic influence of tumor location in patients with stage III colon cancer receiving adjuvant chemotherapy after curative resection. We retrospectively analyzed 274 eligible patients with stage III colon cancer undergoing curative tumor resection followed by adjuvant chemotherapy with oxaliplatin and capecitabine between December 2007 and December 2013. Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan–Meier and log-rank tests, and prognostic factors were identified by Cox regression methods. Patients with RCC exhibited lower hemoglobin levels (23.6% vs. 9.8%; P = 0.002), larger tumor size (60.6% vs. 40.9%; P = 0.001), and a higher proportion of 12 or more resected lymph nodes (86.4% vs. 64.6%; P < 0.001) than patients with LCC. Grade 1 neurotoxicity was more common in patients with RCC than in those with LCC (53.6% vs. 40.9%; P = 0.037). RCC was significantly associated with a shorter 3-year OS than LCC, whereas a difference was noted only for stage IIIC and not stage IIIA or stage IIIB colon cancer. Multivariate analyses revealed that RCC was independently associated with a worse 3-year OS (hazard ratio: 2.213; 95% CI: 1.063–4.606; P = 0.002). In addition, an increase in 3-year OS and DFS after 6–8 cycles of adjuvant chemotherapy was only observed in patients with RCC and not in those with LCC. This study indicated that RCC has a worse prognostic outcome for stage III colon cancer, and a full course of adjuvant chemotherapy should be suggested for patients with RCC.