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J Clin Oncol:早发型结直肠癌患者的治疗依从性优于晚发型,但预后更差!

2021-12-15 MedSci原创 MedSci原创

早发型 (EO) 结直肠癌 (CRC,年龄<50 岁) 的发病率在持续升高。在预期寿命长于晚发型 (LO) 结直肠癌(年龄&ge;50 岁)的人群中,制定最佳辅助治疗方案时应充分考虑患者的治疗依

早发型 (EO) 结直肠癌 (CRC,年龄<50 岁) 的发病率在持续升高。在预期寿命长于晚发型 (LO) 结直肠癌(年龄≥50 岁)的人群中,制定最佳辅助治疗方案时应充分考虑患者的治疗依从性、不良事件和预期结果。


该研究分析了国际辅助化疗持续时间评估数据库中六项试验的个体患者数据,对比了II 期或 III 期早发型结直肠癌和晚发型结直肠癌患者的特征、治疗依从性和不良事件发生情况。为了减少因年龄或合并症的非癌症相关死亡导致的混杂因素,将复发时间(3年复发率)和癌症特异性生存率(5年癌症特异性死亡率)纳入考虑。


不同分期的早发型和晚发型结直肠癌患者的无病生存率


在16349位患者中,有1564位(9.6%)是早发型结直肠癌。与晚发型结直肠癌患者相比,早发型结直肠癌患者有更好的表现状态(86% vs 80%,p<0.01)、相似的T分期(%T1-T3/T4:76/24 vs 77/23,p=0.97)、更高的N2疾病率(24% vs 22%,p<0.01)、更可能完成预定的治疗计划(83.2% vs 78.2%,p<0.01),还可以接受更高的治疗剂量,特别是6个月治疗方案。


不同分期的早发型和晚发型结直肠癌患者的癌症特异性死亡率


早发型结直肠癌患者更常发生胃肠道毒性;晚发型患者更常发生血液学毒性。与晚发型结直肠癌患者相比,早发型结直肠癌患者的癌症特异性预后明显更差,特别是高危的III期结直肠癌患者:3年无复发生存率更低(54% vs 65%;风险比[HR] 1.33, 95% CI 1.14-1.55, p<0.001),5年癌症特异性死亡率更高(24% vs 20%, 95% CI 1.00-1.47, p<0.06)。在该亚组中,3个月或6个月治疗之间的预后无差异,无进展生存率一样的差(57% vs 56%, HR 0.97, 95% CI 0.73-1.29, p=0.85)。
综上,年轻是高风险III期结直肠癌的不良预后因素,与特别高的复发率相关;即便是患者的治疗依从性更好,能耐受更高强度的治疗。
原始出处:
Elisa Fontana, et al. Early-Onset Colorectal Adenocarcinoma in the IDEA Database: Treatment Adherence, Toxicities, and Outcomes With 3 and 6 Months of Adjuvant Fluoropyrimidine and Oxaliplatin. Journal of Clinical Oncology. November 9, 2021. https://ascopubs.org/doi/full/10.1200/JCO.21.02008

 

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    2021-12-25 minlingfeng
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    2021-12-17 fyxzlh
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