Adjuvant Chemotherapy for Stage II Colon Cancer With Poor Prognostic Features
Adjuvant Chemotherapy for Stage II Colon Cancer With Poor Prognostic Features
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DOI：
10.1200/jco.2010.34.3426
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发表时间：
2011-09-01
影响因子：
45.3
通讯作者：
Smith, Maureen A.
中科院分区：
文献类型：
--
作者：
O'Connor, Erin S.;Greenblatt, David Yu;Smith, Maureen A.
辅助化疗通常被认为是II期结肠癌患者的预后不良的特征，包括梗阻，穿孔，急诊入院，T4期，切除少于12个淋巴结，组织学差。尽管经常使用，但化疗对II期疾病患者的生存优势尚未得到证实。我们试图确定化疗的总体生存效益与II期结肠癌患者预后不良feature.Patients和MethodsA共43,032医疗保险受益人进行结肠切除术的II期和III期原发性结肠腺癌诊断1992年至2005年确定的监测，流行病学和最终结果（SEER）-医疗保险数据库。采用卡方（2）和双向方差分析评估患者和疾病相关特征的差异。五年的总生存率进行了检查，使用Kaplan-Meier生存分析和考克斯比例风险回归与倾向评分weighting.ResultsOf 24,847例II期癌症患者，75%有一个或多个预后不良的功能。20%的II期疾病患者和57%的III期疾病患者接受了辅助化疗。校正后，仅在III期疾病患者中观察到化疗的5年生存获益（风险比[HR]，0.64; 95%CI，0.60 - 0.67）。对于没有不良预后特征的II期癌症患者，没有观察到生存益处（HR，1.02; 95% CI，0.84 - 1.25）或具有任何不良预后特征的II期癌症（HR，1.03; 95%CI，0.94至1.13）。结论在被确定为II期结肠癌的医疗保险患者中，无论是否有预后不良的特征，辅助化疗并没有显著提高总生存率。这种缺乏益处的情况必须在类似的老年结肠癌患者的治疗决策中加以考虑。J Clin Oncol 29：3381-3388. (C)2011年美国临床肿瘤学会
PurposeAdjuvant chemotherapy is typically considered for patients with stage II colon cancer characterized by poor prognostic features, including obstruction, perforation, emergent admission, T4 stage, resection of fewer than 12 lymph nodes, and poor histology. Despite frequent use, the survival advantage conferred on patients with stage II disease by chemotherapy is yet unproven. We sought to determine the overall survival benefit of chemotherapy among patients with stage II colon cancer having poor prognostic features.Patients and MethodsA total of 43,032 Medicare beneficiaries who underwent colectomy for stage II and III primary colon adenocarcinoma diagnosed from 1992 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) -Medicare database. chi(2) and two-way analysis of variance were used to assess differences in patient-and disease-related characteristics. Five-year overall survival was examined using Kaplan-Meier survival analysis and Cox proportional hazards regression with propensity score weighting.ResultsOf the 24,847 patients with stage II cancer, 75% had one or more poor prognostic features. Adjuvant chemotherapy was received by 20% of patients with stage II disease and 57% of patients with stage III disease. After adjustment, 5-year survival benefit from chemotherapy was observed only for patients with stage III disease (hazard ratio[HR], 0.64; 95% CI, 0.60 to 0.67). No survival benefit was observed for patients with stage II cancer with no poor prognostic features (HR, 1.02; 95% CI, 0.84 to 1.25) or stage II cancer with any poor prognostic features (HR, 1.03; 95% CI, 0.94 to 1.13).ConclusionAmong Medicare patients identified with stage II colon cancer, either with or without poor prognostic features, adjuvant chemotherapy did not substantially improve overall survival. This lack of benefit must be considered in treatment decisions for similar older adults with colon cancer. J Clin Oncol 29:3381-3388. (C) 2011 by American Society of Clinical Oncology