高风险、切除的结直肠癌患者接受和不接受维持治疗的生存结局

M. Auber, S. Wen, Francesca Farran, G. Higa
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摘要

导读:结直肠癌的死亡率比乳腺癌或前列腺癌高得多,尽管大多数新病例在诊断时是可以治愈的。如果只有一半的死亡是由于诊断时的转移性疾病,那么其余的一部分死亡必须归因于早期疾病的推定治愈治疗后的肿瘤复发。如果是这样的话,对于相当多的受试者来说,后一组的当前管理是次优的,这一观点主张对维持治疗进行评估。此外,大多数复发发生在标准手术和(新)辅助治疗后的24个月内。目的:评估高风险切除肿瘤患者在按照公认的指南完成治疗后接受和未接受维持治疗的无复发生存期和总生存期。方法:收集85例患者的相关临床资料,其中37例接受维持治疗,48例未接受维持治疗。对累积的数据进行与生存结果相关的描述性统计分析。分别采用Wilcoxon秩检验和Fisher精确检验对连续变量和分类变量进行检验。采用Kaplan-Meier法和log-rank检验分析组间无复发生存率和总生存率。结果:在整个队列中,85名受试者中有63名(74.1%)没有疾病证据,中位时间为辅助治疗结束后5年。Kaplan-Meier分析显示,治疗组和未治疗组患者的5年无复发生存中位数(79.8% vs 69.2%)和总生存中位数(87.8% vs 81.7%)在统计学上(但不一定是临床)无显著差异。共有21名受试者死亡;7人中的3人(治疗组)和全部14人(未治疗组)死于癌症。结论:维持治疗在临床上比p值更有效的提示被掩盖了。这项回顾性数据收集和分析的结果表明,一些早期、高风险疾病的患者通过维持治疗将获得生存益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Survival Outcomes in High-Risk, Resected Colorectal Cancer with and without Maintenance Therapy
Introduction: Deaths due to colorectal cancer are disproportionately higher than either breast or prostate cancers even though the majority of new cases are potentially curable at diagnoses. If only half of the losses is due to metastatic disease at diagnosis, then a share of the remaining deaths must be attributable to tumor recurrence after presumptively curative therapy of early-stage disease. If so, current management of the latter group is suboptimal for a considerable number of subjects, a perception which argues for an assessment of maintenance therapy. Moreover, most recurrences occur within 24 months after standard surgical and (neo)adjuvant therapies. Objective: To assess relapse-free and overall survival among patients with high-risk, resected tumors who did and did not receive maintenance therapy following completion of treatment according to accepted guidelines. Methods: Pertinent clinical details were collected on 85 subjects, 37 who were, and 48 who were not, treated with maintenance therapy. Descriptive statistical analyses related to survival outcomes were performed on accumulated data. Wilcoxon rank test and Fisher’s exact test were used to examine the continuous and categorical variables, respectively. Kaplan-Meier method and log-rank test were used to analyze between-group relapse-free and overall survival. Results: Of the entire cohort, 63 of 85 (74.1%) subjects have no evidence of disease, a median of 5 years from the end of adjuvant therapy. Kaplan-Meier analyses indicated statistically, but not necessarily clinically, non-significant differences in median 5-year relapse-free survival, 79.8% vs 69.2%, and overall survival, 87.8% vs 81.7% in the treated and untreated groups of patients, respectively. A total of 21 subjects died; three of seven (treated group) and all 14 (untreated group) due to cancer. Conclusion: Obscured is the hint that maintenance therapy is clinically more effective than what the p-value intimates. The results of this retrospective data collection and analyses suggest that some patients with early-stage, high-risk disease, will derive survival benefits with maintenance therapy.
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