CAJ | 학술논문

目的:对Ⅱ期结肠癌根治术后接受奥沙利铂联合氟尿嘧啶类药物辅助化疗疗效进行评价,并对临床获益人群进行探索性分析.方法:对中国医学科学院肿瘤医院2005年1月至2008年12月接受结肠癌根治术、术后分期为Ⅱ期患者回顾性分析,比较单纯手术和术后奥沙利铂联合氟尿嘧啶类药物辅助化疗的无瘤生存率(Disease-Free Survive,DFS)和总生存率(Overall Sur?vival,OS)差异.采用Kaplan-Merier进行生存分析,Log-rank检验进行组间差异比较,亚组分析采用Cox风险比例模型.结果:全组患者中位年龄62岁,单纯手术患者111例,术后采用奥沙利铂联合5-氟尿嘧啶(5-FU)或其衍生物的方案辅助治疗155例.全部患者中位随访时间为59(16~87)个月.单纯手术组和术后辅助治疗组5年无瘤生存率为86.5%和90.2%(HR=0.596,95%CI:0.295~1.208,P=0.152),5年生存率分别为88.3%和92.9%(HR=0.576,95%CI:0.248~1.338,P=0.199),两组间差异无统计学意义.亚组分析显示:T4、低分化(包括印戒细胞癌)腺癌、具有2个及以上高危因素(高危因素包括肠梗阻穿孔、淋巴结清扫少于12枚、脉管瘤栓、神经侵犯)、CEA>5ng/mL患者术后辅助治疗能明显提高无瘤生存(P均<0.05).结论:部分Ⅱ期结肠癌患者,包括肿瘤浸润程度为T4、低分化腺癌、具有2个及以上高危因素、术前CEA>5 ng/mL可能从术后奥沙利铂联合氟尿嘧啶治疗中获益.
목적:대Ⅱ기결장암근치술후접수오사리박연합불뇨밀정류약물보조화료료효진행평개,병대림상획익인군진행탐색성분석.방법:대중국의학과학원종류의원2005년1월지2008년12월접수결장암근치술、술후분기위Ⅱ기환자회고성분석,비교단순수술화술후오사리박연합불뇨밀정류약물보조화료적무류생존솔(Disease-Free Survive,DFS)화총생존솔(Overall Sur?vival,OS)차이.채용Kaplan-Merier진행생존분석,Log-rank검험진행조간차이비교,아조분석채용Cox풍험비례모형.결과:전조환자중위년령62세,단순수술환자111례,술후채용오사리박연합5-불뇨밀정(5-FU)혹기연생물적방안보조치료155례.전부환자중위수방시간위59(16~87)개월.단순수술조화술후보조치료조5년무류생존솔위86.5%화90.2%(HR=0.596,95%CI:0.295~1.208,P=0.152),5년생존솔분별위88.3%화92.9%(HR=0.576,95%CI:0.248~1.338,P=0.199),량조간차이무통계학의의.아조분석현시:T4、저분화(포괄인계세포암)선암、구유2개급이상고위인소(고위인소포괄장경조천공、림파결청소소우12매、맥관류전、신경침범)、CEA>5ng/mL환자술후보조치료능명현제고무류생존(P균<0.05).결론:부분Ⅱ기결장암환자,포괄종류침윤정도위T4、저분화선암、구유2개급이상고위인소、술전CEA>5 ng/mL가능종술후오사리박연합불뇨밀정치료중획익.
Objective:This study aims to prove the survival advantage given to patients with stageⅡ colon cancer through che-motherapy. Methods:The clinical and pathological data of stageⅡcolon cancer patients with radical resection from January 2005 to December 2008 were retrospectively evaluated. The difference in disease-free survival (DFS) and the overall survival (OS) between patients who received oxaliplatin and fluorouracil as adjuvant treatment (n=155) and those who did not receive adjuvant chemotherapy (n=111) were compared. Theχ2 and two-way analysis of variance were used to assess the difference in patient-and disease-related characteristics. The overall and five-year disease-free survival data were examined using the Kaplan-Meier survival analysis and Cox proportional hazards regression with propensity score weighting. Results:The five-year DFS rates were 90.2%and 86.5%in the adjuvant treatment and surgical only groups, respectively (HR=0.59, 95%CI 0.295-1.208, P=0.152). The five-year OS rates were 92.9%and 88.3%in the adjuvant treatment and surgical only group, respectively (HR=0.576, 95%CI 0.248-1.338, P=0.199). No survival benefit was observed in patients with stageⅡcolon cancer. Patients with T4 stage, poor histology, more than one high risk factor, or carcinoembryonic antigen (CEA)>5 ng/ml had higher five-year DFS through adjuvant chemotherapy. Conclusion:Oxaliplatin and fluorouracil adjuvant treatment did not substantially improve the DFS and OS of all patients with stageⅡcolon cancer. However, patients with T4 stage, poor histology, more than one high risk factor, or CEA>5 ng/ml could benefit from adjuvant chemotherapy.