Adjuvant chemotherapy improves prognosis of resectable stage IV colorectal cancer: a comparative study using inverse probability of treatment weighting
Adjuvant chemotherapy improves prognosis of resectable stage IV colorectal cancer: a comparative study using inverse probability of treatment weighting
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DOI：
10.1177/1758835919838960
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发表时间：
2019-04-01
影响因子：
4.9
通讯作者：
Nakajima, Jun
中科院分区：
文献类型：
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作者：
Nozawa, Hiroaki;Takiyama, Hirotoshi;Nakajima, Jun
背景：已知辅助化疗（AC）对III期结直肠癌（CRC）有益。相反，只有少数研究报道了AC对IV期CRC根治性手术后的生存益处。方法：我们确定了2003年至2017年期间在我院接受根治性手术的155例各种器官转移的CRC患者。回顾临床病理参数和术后AC。进行多变量分析以确定预后因素。此外，AC对无复发生存期（RFS）和总生存期（OS）的影响进行了分析，使用治疗加权的逆概率。结果：该队列包括94名男性和61名女性，平均年龄为63岁。2003年至2010年期间接受手术的患者中有57%接受了AC治疗，2011年至2017年期间为76%（p = 0.015）。AC更可能用于具有良好体能状态、术前白蛋白水平高、区域淋巴结和腹膜转移且术中未输血的患者。多变量分析将AC确定为RFS和OS的显著预后因素[风险比（HR）分别为1.86，p = 0.003和2.66，p = 0.002]。在调整不同背景后，接受AC的患者的5年RFS和OS率（27%和67%）高于未接受AC的患者（14%和46%，p < 0.0001和p = 0.0005）。亚组分析显示，AC显著改善了淋巴结阴性患者的RFS（HR：2.16，p = 0.029）和淋巴结阳性患者的RFS和OS（HR：2.03，p < 0.0001和2.02，p = 0.001）。结论：AC可以与可切除的IV期结直肠癌患者讨论，因为它显着的生存改善效果。
Background: Adjuvant chemotherapy (AC) is known to be beneficial for stage III colorectal cancer (CRC). In contrast, only a few studies have reported the survival benefits of AC for stage IV CRC after curative surgery. Methods: We identified 155 CRC patients with various organ metastases who underwent curative surgery in our hospital between 2003 and 2017. Clinicopathological parameters and postoperative AC were reviewed. Multivariate analyses were performed to identify prognostic factors. Moreover, the effects of AC on recurrence-free survival (RFS) and overall survival (OS) were analyzed using inverse probability of treatment weighting. Results: The cohort comprised 94 males and 61 females, with a mean age of 63 years. AC was administered to 57% of patients who underwent surgery between 2003 and 2010 and 76% between 2011 and 2017 (p = 0.015). AC was more likely administered to patients with a good performance status, high preoperative albumin level, regional node and peritoneal metastases, and no intraoperative blood transfusion. Multivariate analyses identified AC as a significant prognostic factors for RFS and OS [hazard ratio (HR): 1.86, p = 0.003, and 2.66, p = 0.002, respectively]. After adjusting for different backgrounds, 5-year RFS and OS rates were higher in patients receiving AC (27% and 67%) than in those without AC (14% and 46%, p < 0.0001 and p = 0.0005). Subgroup analyses showed that AC significantly improved RFS in node-negative patients (HR: 2.16, p = 0.029), and RFS and OS in node-positive patients (HR: 2.03, p < 0.0001, and 2.02, p = 0.001, respectively). Conclusion: AC can be discussed with resectable stage IV CRC patients because of its significant survival-improving effects.