Adjuvant chemotherapy for stage III colon cancer - Implications of race/ethnicity, age, and differentiation
Adjuvant chemotherapy for stage III colon cancer - Implications of race/ethnicity, age, and differentiation
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DOI：
10.1001/jama.294.21.2703
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发表时间：
2005-12-07
影响因子：
120.7
通讯作者：
Minsky, BD
中科院分区：
文献类型：
--
作者：
Jessup, JM;Stewart, A;Minsky, BD
1990年美国国立卫生研究院共识会议建议III期结肠癌患者接受辅助化疗，因为在接受5-氟尿嘧啶为基础的治疗方案的患者的临床试验中，生存率得到了改善。背景和参与者来自560家医院癌症登记处的85934例III期结肠癌患者的前瞻性数据输入1990年至2002年期间的国家癌症数据库，包括标准临床，病理，主要结果测量辅助化疗的使用率和5-FU的使用率。结果辅助化疗的使用从1991年的39%增加到2002年的64%，但在黑人、女性和老年患者中较低。与单纯手术相比，5年生存率从1991年的近8%提高到1997年的16%以上。辅助化疗增加老年患者的生存率与年轻患者一样多。然而，在黑人辅助化疗的好处，那些与高级别的癌症是不是很大。结论辅助化疗的使用增加了1990年至2002年的III期结肠癌患者的5年生存率增加了16%。辅助化疗的益处似乎在黑人患者和高级别癌症中较低。妇女享有同样的福利，但较少接受治疗。老年患者与年轻患者具有相同的益处，但治疗频率较低。2004-2005年辅助治疗的新选择可能会进一步改善III期结肠癌患者的预后。
Context A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy because survival was improved in clinical trials in patients who received a 5-fluorouracil-based regimen.Objective To determine whether adjuvant chemotherapy is used in the community as a standard of practice that improves outcome and whether it failed to benefit any specific sets of patients.Design, Setting, and Participants Prospective data from 85 934 patients with stage III colon cancer from 560 hospital cancer registries were entered into the National Cancer Data Base between 1990 and 2002 and included standard clinical, pathological, and first course of treatment variables.Main Outcome Measures Prevalence of adjuvant chemotherapy usage and 5-year survival in patients treated in US hospitals.Results Adjuvant chemotherapy use increased from 39% in 1991 to 64% in 2002 but was lower in black, female, and elderly patients. It improved 5-year survival from almost 8% in 1991 to more than 16% in 1997 compared with surgery alone. Adjuvant chemotherapy increases survival in elderly patients as much as it does in younger patients. However, the benefit of adjuvant chemotherapy in blacks and, those with high-grade cancers is not as great.Conclusions Adjuvant chemotherapy use has increased from 1990 to 2002 for patients with stage III colon cancer with an associated increase in 5-year survival of 16%. The benefit of adjuvant chemotherapy seems to be lower in black patients and high-grade cancers. Women have the same benefit but are less often treated. Elderly patients have the same benefit as younger patients but are less frequently treated. New options for adjuvant therapy in 2004-2005 may further improve the outcome of patients with stage III colon cancer.