Impact of Age on the Efficacy of Newer Adjuvant Therapies in Patients With Stage II/III Colon Cancer: Findings From the ACCENT Database
Impact of Age on the Efficacy of Newer Adjuvant Therapies in Patients With Stage II/III Colon Cancer: Findings From the ACCENT Database
复制标题
DOI：
10.1200/jco.2013.49.6638
复制
发表时间：
2013-07-10
影响因子：
45.3
通讯作者：
Sargent, Daniel J.
中科院分区：
文献类型：
--
作者：
McCleary, Nadine J.;Meyerhardt, Jeffrey A.;Sargent, Daniel J.
目的：既往研究表明，II/III期结肠癌患者无论年龄大小，静脉注射（IV）氟嘧啶辅助治疗均能获得相似的获益。联合方案和口服氟尿嘧啶（FU）治疗现在是标准。我们研究了年龄对结肠癌复发率和死亡率的影响，辅助治疗后，这些较新的选项Patients and MethodsWe分析了11，953例患者年龄70岁，从7个辅助治疗试验比较IV FU与口服氟尿嘧啶（卡培他滨，尿嘧啶，或替加氟）或组合的氟尿嘧啶与奥沙利铂或伊立替康在II/III期结肠癌。终点为无病生存期（DFS）、总生存期（OS）和复发时间（TTR.ResultsIn三项比较奥沙利铂为基础的化疗与IV FU的研究中，治疗组与年龄之间未观察到统计学显著的相互作用（P交互作用= DFS为0.09，OS为0.05，TTR为0.36），尽管分层点估计表明老年患者加用奥沙利铂的获益有限（DFS风险比[HR]，0.94; 95% CI，0.78 - 1.13; OS HR，1.04; 95% CI，0.85 - 1.27）。没有显着的相互作用，检测到与口服氟尿嘧啶治疗相比，IV FU的年龄，非劣效性支持在两个年龄population.ConclusionPatients年龄>= 70岁似乎经历了减少的好处，从添加奥沙利铂氟嘧啶在辅助设置，虽然统计学上，有没有一个显着的效果修改年龄，而口服氟嘧啶保留其疗效。(C)2013年美国临床肿瘤学会
PurposePrior studies have suggested that patients with stage II/III colon cancer receive similar benefit from intravenous (IV) fluoropyrimidine adjuvant therapy regardless of age. Combination regimens and oral fluorouracil (FU) therapy are now standard. We examined the impact of age on colon cancer recurrence and mortality after adjuvant therapy with these newer options.Patients and MethodsWe analyzed 11,953 patients age 70 years from seven adjuvant therapy trials comparing IV FU with oral fluoropyrimidines (capecitabine, uracil, or tegafur) or combinations of fluoropyrimidines with oxaliplatin or irinotecan in stage II/III colon cancer. End points were disease-free survival (DFS), overall survival (OS), and time to recurrence (TTR).ResultsIn three studies comparing oxaliplatin-based chemotherapy with IV FU, statistically significant interactions were not observed between treatment arm and age (P interaction = .09 for DFS, .05 for OS, and .36 for TTR), although the stratified point estimates suggested limited benefit from the addition of oxaliplatin in elderly patients (DFS hazard ratio [HR], 0.94; 95% CI, 0.78 to 1.13; OS HR, 1.04; 95% CI, 0.85 to 1.27). No significant interactions by age were detected with oral fluoropyrimidine therapy compared with IV FU; noninferiority was supported in both age populations.ConclusionPatients age >= 70 years seemed to experience reduced benefit from adding oxaliplatin to fluoropyrimidines in the adjuvant setting, although statistically, there was not a significant effect modification by age, whereas oral fluoropyrimidines retained their efficacy. (C) 2013 by American Society of Clinical Oncology