摘要
目的:对结肠癌根治术后患者辅助化疗的疗效进行评价,并对影响预后的因素进行分析。方法:对中国医学科学院肿瘤医院1996年5月至2006年5月接受结肠癌根治术后辅助化疗的196例患者临床资料进行回顾性分析。采用Kaplan-Meier法计算生存率。生存率的比较采用Log-rank检验。预后因素分析采用Cox比例风险模型。结果:全组患者中位年龄55岁(25～72岁),Ⅰ期2例(1.0%),Ⅱ期92例(46.9%),Ⅲ期102例(52.0%)。术后病理分期:T_2 6例(3.1%),T_3 36例(18.4%),T_4 154例(78.6%)。N_0 92例(46.9%),N_1 67例(34.2%),N_2 37例(18.9%)。所有患者化疗均采用含5-氟尿嘧啶(5-FU)或其衍生物的方案。全部生存患者中位随访时间为54个月(24～136个月)。总的3年和5年无瘤生存率(DFS)分别为70.2%和67.2%,3年和5年总生存率(OS)分别为84.7%和75.1%。应用含草酸铂方案(124例)和不含草酸铂方案(72例)患者之间的无瘤生存率(HR=0.711,95%CI 0.431～1.174,P=0.183)和总生存率(HR=0.643,95%CI 0.344～1.200,P=0.265)无统计学差异。单因素分析发现,年龄、病理类型、病理淋巴结分期和临床分期是影响患者无瘤生存的重要预后因素。病理类型、病理淋巴结分期、临床分期也是影响总生存率的重要因素。多因素分析发现,临床分期是唯一影响患者无瘤生存的预后因素。病理淋巴结分期和临床分期是影响总生存的因素。全组75%患者复发转移发生于术后2年内,中位转移时间为14个月。转移后中位生存时间为15个月。肝脏是最常见转移部位(35.6%)。结论:临床分期是影响结肠癌患者生存的主要因素。5-氟尿嘧啶为基础的化疗仍然是结肠癌辅助治疗标准方案。
Objective： Adjuvant chemotherapy for patients with stage Ⅲ and high risk stage Ⅱ colon cancer has been demonstrated to improve patient outcome in a series of randomized clinical trials in western countries. We therefore assessed the efficacy of adjuvant chemotherapy in Chinese colon cancer patients in our clinical practice. Prognostic factors were also analyzed. Methods： Clinical data of 196 patients treated with colon cancer resection were retrospectively evaluated. All of these patients received adjuvant chemotherapy at our hospital between May 1996 and May 2006. Kaplan-Meier survival curves were generated. Cox proportional models were used to conduct univariate and multivariate analyses of prognostic factors. Results： The median age was 55 years. Among these colon cancer patients, 2 （1.0%） were of stage Ⅰ, 92 （46.9%） were of stage Ⅱ and 102 （52.0%） were of stage Ⅲ. Regarding pathologic T staging, 6 （3.1%） patients were pT2, 36 （18.4%） patients were pT3 and 154 （78.6%） patients were pT4. Regarding pathologic lymph node staging, 92 （46.9.0%） patients were pN0, 67 （34.2%） patients were pN1, and 37 （18.9%） were pN2. All of the patients received 5-fluorouracil-based chemotherapy. The 3- and 5- year recurrence-free survival rates were 70.2% and 67.2%, respectively. The 3- and 5- year survival rates were 84.7% and 75.1%, respectively. No significant benefit was found in DFS （HR, 0.711; 95% CI, 0.431-1.174; P=0.183） or OS （HR, 0.711; 95% CI, 0.431-1.174; P= 0.183） if patients were treated with additional oxaliplatin （n=125）. Univariate analysis indicated that age, pathological type, pN stage and clinical stage were significant prognostic factors for DFS. Pathological type, pN stage and clinical stage were significant prognostic factors for OS. Multivariate analysis indicated that clinical stage was the only independent prognostic factor for DFS. pN stage and clinical stage were independent prognostic factors for OS. Seventy-five percent of recurrences were seen within 2 years after surgery. The overall median survival after recurrence was 15 months. The liver was the most common site of metastasis （35.6%）. Conclusion： Staging is the most important prognostic determinant of colon cancer. A 5-FU-based regimen remains the standard option for adjuvant chemotherapy in patients after colon cancer resection.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2009年第7期368-371,共4页
Chinese Journal of Clinical Oncology
关键词
结肠肿瘤
辅助化疗
5-氟尿嘧啶
草酸铂
预后
Colonic neoplasm
Adjuvant chemotherapy
Fluorouracil
Oxaliplatin
Prognosis
