Postoperative chemotherapy is associated with prognosis of stage IV colorectal cancer treated with preoperative chemotherapy/chemoradiotherapy and curative resection
Postoperative chemotherapy is associated with prognosis of stage IV colorectal cancer treated with preoperative chemotherapy/chemoradiotherapy and curative resection
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DOI：
10.1007/s00384-019-03461-5
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发表时间：
2019-12-05
影响因子：
2.8
通讯作者：
Ishihara, Soichiro
中科院分区：
文献类型：
--
作者：
Nozawa, Hiroaki;Sonoda, Hirofumi;Ishihara, Soichiro
目的：全身化疗的进展增加了结直肠癌（CRC）转移相关的可切除性，即使它最初是不可切除的。然而，决定IV期CRC患者术前治疗和手术预后的因素尚不清楚。我们试图确定这类CRC患者的预后因素。方法回顾2007年12月至2019年5月期间接受根治性切除术的IV期结直肠癌患者。包括因最初不可切除的疾病而接受转换化疗的患者，以及因可切除的同步转移而接受新辅助化疗（NAC）或因可切除转移的晚期下直肠癌接受新辅助放化疗（NACRT）的患者。采用Cox比例风险模型进行多变量分析，检查无复发生存期（RFS）和总生存期（OS）。根据术后辅助化疗（AC）分析RFS和OS曲线。结果在70例接受根治性手术的患者中（34例男性，平均年龄：60岁），33例最初不可切除，23例接受NAC， 14例接受NACRT。通过多变量分析，AC是改善RFS和OS的独立预测因子（风险比= 0.29,p = 0.0002，风险比= 0.37,p = 0.025）。接受AC治疗的患者的RFS和OS均优于未接受AC治疗的患者（2年RFS率= 30% vs 19%, p = 0.031, 3年OS率= 87% vs 67%, p = 0.045）。结论IV期结直肠癌患者在根治性切除后，不论其初始可切除性和术前治疗情况，均应考虑行AC手术，因为AC与预后改善有关。
Purpose Advances in systemic chemotherapy have increased the resectability in colorectal cancer (CRC) associated with metastases even if it was initially unresectable. However, what determines the prognosis of stage IV CRC patients treated by preoperative therapy and surgery remains unclear. We attempted to identify prognostic factors in such CRC patients. Methods We reviewed stage IV CRC patients who underwent curative resection between December 2007 and May 2019. The patients who underwent conversion chemotherapy for initially unresectable disease and those who received neoadjuvant chemotherapy (NAC) for resectable synchronous metastases or neoadjuvant chemoradiotherapy (NACRT) for advanced lower rectal cancer with resectable metastases were included. Recurrence-free survival (RFS) and overall survival (OS) were examined by multivariate analyses using Cox proportional hazard models. The RFS and OS curves were analyzed according to postoperative adjuvant chemotherapy (AC). Results Among 70 patients who underwent curative surgery (34 men, mean age: 60 years old), 33 had initially unresectable disease, 23 received NAC, and 14 NACRT. By multivariate analyses, AC was an independent predictor for improved RFS and OS (hazard ratio = 0.29, p = 0.0002, and hazard ratio = 0.37, p = 0.025). Patients treated with AC showed improved RFS and OS than those without AC (2-year RFS rate = 30% vs 19%, p = 0.031, and 3-year OS rate = 87% vs 67%, p = 0.045). Conclusion Because of its association with improved prognosis, AC should be considered for stage IV CRC patients after curative resection regardless of initial resectability status and preoperative therapy.