CAJ | 학술논문

目的：观察老年高危Ⅱ期和Ⅲ期结直肠癌根治术后辅助化学治疗的临床效果和不良反应。方法选取2011年7月—2012年12月在我院住院治疗的老年高危Ⅱ期和Ⅲ期结直肠癌523例，根据患者及其家属是否同意化学治疗分为化学治疗组(230例)和非化学治疗组(293例)，化学治疗方案为FOLFOX方案(氟尿嘧啶+奥沙利铂+亚叶酸钙)、XELOX方案(奥沙利铂+卡培他滨)和SOX方案(奥沙利铂+替吉奥胶囊)，比较两组术后1年和2年的无病生存率、总复发和转移率及无病生存期，并观察化学治疗组不良反应发生情况。结果523例均完成研究。化学治疗组无病生存期长于非化学治疗组，术后2年总复发和转移率低于非化学治疗组，术后2年无病生存率高于非化学治疗组，两组比较差异均具有统计学意义(P<0．05)。 Kaplan-Meier生存曲线分析结果显示两组术后2年无病生存率比较差异有统计学意义(P<0．05)。化学治疗组出现的不良反应主要有消化系统反应、骨髓抑制、肝功能损害、外周神经毒性及手足综合征，但经对症处理后患者多可耐受，不影响治疗。结论老年高危Ⅱ期和Ⅲ期结直肠癌根治术后辅助化学治疗效果良好，且患者耐受性较好。
목적：관찰노년고위Ⅱ기화Ⅲ기결직장암근치술후보조화학치료적림상효과화불량반응。방법선취2011년7월—2012년12월재아원주원치료적노년고위Ⅱ기화Ⅲ기결직장암523례，근거환자급기가속시부동의화학치료분위화학치료조(230례)화비화학치료조(293례)，화학치료방안위FOLFOX방안(불뇨밀정+오사리박+아협산개)、XELOX방안(오사리박+잡배타빈)화SOX방안(오사리박+체길오효낭)，비교량조술후1년화2년적무병생존솔、총복발화전이솔급무병생존기，병관찰화학치료조불량반응발생정황。결과523례균완성연구。화학치료조무병생존기장우비화학치료조，술후2년총복발화전이솔저우비화학치료조，술후2년무병생존솔고우비화학치료조，량조비교차이균구유통계학의의(P<0．05)。 Kaplan-Meier생존곡선분석결과현시량조술후2년무병생존솔비교차이유통계학의의(P<0．05)。화학치료조출현적불량반응주요유소화계통반응、골수억제、간공능손해、외주신경독성급수족종합정，단경대증처리후환자다가내수，불영향치료。결론노년고위Ⅱ기화Ⅲ기결직장암근치술후보조화학치료효과량호，차환자내수성교호。
Objective To observe the efficacy and side effects of adjuvant chemotherapy in elderly patients with high-risk stage Ⅱ and stage Ⅲ colorectal cancer after radical resection surgery. Methods A total of 523 patients with high-risk stage Ⅱ and stage Ⅲ colorectal cancer were selected in our hospital during July 2011 and December 2012. With informed consent of the patients and their family members, they were divided into chemotherapy group (n=230) and non-chemotherapy group (n=293). The patients in chemotherapy group were assigned to receive FOLFOX regimen (fluorouracil plus oxaliplatin and calcium folinate) , XELOX regimen ( oxaliplatin plus capecitabine) or SOX regimen ( oxaliplatin plus S-1 capsule) . The difference of disease-free survival ( DFS) , tumor relapse and metastasis rates in two groups were analyzed one year and two years after surgery, and side effects of chemotherapy group were observed. Results All the patients completed the following up. Disease-free survival time of the chemotherapy group was longer than that of the non-chemotherapy group, the 2-year total relapse and metastasis rates of the chemotherapy group were lower than those of the non-chemotherapy group, and the 2-year disease-free survival rate of the chemotherapy group was higher than that of the non-chemotherapy group, and the differences were all statistically significant ( P<0. 05 ) . Kaplan-Meier survival analysis showed significant difference of 2-year DFS rate between the two groups (P<0. 05). Major adverse effects of the chemotherapy group were gastrointestinal disturbance, bone marrow suppression, liver dysfunction, peripheral neuropathy and hand-foot syndrome. After symptomatic treatment, all pa-tients could tolerate without effect of treatment. Conclusion Adjuvant chemotherapy maintains better efficacy in elderly pa-tients with high-risk stage Ⅱ and stage Ⅲ colorectal cancer after radical resection surgery, and could be better tolerated.