The impact of early adjuvant chemotherapy in rectal cancer
The impact of early adjuvant chemotherapy in rectal cancer
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DOI：
10.1371/journal.pone.0228060
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发表时间：
2020-01-31
期刊：
影响因子：
3.7
通讯作者：
Min, Byung Soh
中科院分区：
文献类型：
--
作者：
Noh, Gyoung Tae;Han, Jeonghee;Min, Byung Soh
虽然辅助化疗（AC）已被确立为晚期直肠癌的标准治疗方法，但关于AC开始的时间尚无指导原则。在这项研究中，我们的目的是评估早期AC启动的肿瘤学结果，并澄清理想的时间AC直肠癌患者接受术前放化疗（preCRT）。MethodsThe病历719例患者进行根治性切除术后AC直肠癌进行了回顾性分析。根据AC启动、生存结果和化疗诱导毒性的计算临界值比较数据分布。此外，患者被分为两组，根据preCRT状态和比较的最佳时间AC的差异。结果总体而言，截止时间点为20天手术后的AC启动被确定为最佳的间隔，这产生了无病生存率的显着差异，但没有显着差异AC毒性。在未接受预CRT治疗的患者的截止值分析中，19天被确定为至AC的最佳时间。然而，对于接受预CRT治疗的患者，没有显着的价值影响生存outcome.ConclusionsEarlier启动AC（约3周内）与直肠癌患者更好的肿瘤学结果。此外，在接受preCRT的患者中，AC的最佳时间尚不清楚;这可能是由于preCRT后AC的作用不确定或吻合口瘘等并发症的影响。
PurposesAlthough adjuvant chemotherapy (AC) has been established as a standard of treatment for advanced rectal cancer, there is no guideline regarding the timing of AC initiation. In this study, we aimed to evaluate the oncologic outcome of early AC initiation and clarify the ideal time to AC among rectal cancer patients receiving preoperative chemo-radiotherapy (preCRT).MethodsThe medical records of 719 patients who underwent curative resection followed by AC for rectal cancer were analyzed retrospectively. Data distributions were compared according to the calculated cut-off for AC initiation, survival results, and chemotherapy-induced toxicity. Additionally, patients were divided into two groups according to preCRT status and compared with respect to differences in the optimal time to AC.ResultsOverall, a cut-off time point of 20 days after surgery for AC initiation was identified as the optimal interval; this yielded a significant difference in disease-free survival but no significant difference in AC toxicity. In the cut-off analysis of patients treated without preCRT, 19 days was identified as the optimal time to AC. However, for patients treated with preCRT, no significant value affected the survival outcome.ConclusionsEarlier initiation of AC (within approximately 3 weeks) was associated with better oncological outcomes among patients with rectal cancer. Additionally, the optimal timing of AC was unclear among patients who received preCRT; this might be attributable to an undetermined role of AC after preCRT or the effects of complications such as anastomotic leakage.