American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer
American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer
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DOI：
10.1200/jco.2004.05.063
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发表时间：
2004-08-15
影响因子：
45.3
通讯作者：
Haller, DG
中科院分区：
文献类型：
--
作者：
Benson, AB;Schrag, D;Haller, DG
目的探讨是否应该将辅助化疗作为常规临床操作的一部分，以确定预后较差的患者，并描述可供肿瘤学家在实践中讨论辅助化疗的策略。方法美国临床肿瘤学会小组与安大略省癌症护理实践指南倡议合作，回顾了截至2003年5月的文献中的相关信息。结果一项基于文献的荟萃分析发现，没有证据表明辅助化疗对II期结肠癌患者的生存有显著的统计学意义。建议不建议对符合医学条件的II期结肠癌患者常规使用辅助化疗。然而，有一些II期结肠癌患者可以考虑进行辅助治疗，包括采样不充分的结节、T4病变、穿孔或组织学低分化的患者。结论来自随机对照试验的直接证据不支持对II期结肠癌患者常规使用辅助化疗。接受III期疾病的相对益处作为II期疾病益处的充分间接证据的患者和肿瘤学家有理由考虑使用辅助化疗，特别是对那些高危II期疾病的患者。最终的临床决定应该基于与患者的讨论，关于支持治疗的证据的性质，治疗的预期发病率，个体预后的高危预后特征的存在，以及患者的偏好。应该鼓励II期疾病的患者参加随机试验。
Purpose To address whether all medically fit patients with curatively resected stage II colon cancer should be offered adjuvant chemotherapy as part of routine clinical practice, to identify patients with poor prognosis characteristics, and to describe strategies for oncologists to use to discuss adjuvant chemotherapy in practice.Methods An American Society of Clinical Oncology Panel, in collaboration with the Cancer Care Ontario Practice Guideline Initiative, reviewed pertinent information from the literature through May 2003.Results A literature-based meta-analysis found no evidence of a statistically significant survival benefit of adjuvant chemotherapy for stage II patients.Recommendations The routine use of adjuvant chemotherapy for medically fit patients with stage II colon cancer is not recommended. However, there are populations of patients with stage II disease that could be considered for adjuvant therapy, including patients with inadequately sampled nodes, T4 lesions, perforation, or poorly differentiated histology.Conclusion Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer. Patients and oncologists who accept the relative benefit in stage III disease as adequate indirect evidence of benefit for stage II disease are justified in considering the use of adjuvant chemotherapy, particularly for those patients with high-risk stage II disease. The ultimate clinical decision should be based on discussions with the patient about the nature of the evidence supporting treatment, the anticipated morbidity of treatment, the presence of high-risk prognostic features on individual prognosis, and patient preferences. Patients with stage II disease should be encouraged to participate in randomized trials.