Dukes B或C期结肠癌术后腹腔化疗和／或静脉化疗对存活的影响

Effects of Postoperative Intraperitoneal and/or Intravenous Chemotherapy on the survival of patients with Dukes stage B or C Colon Cancer

目的：评估术后静脉化疗、腹腔化疗或腹腔化疗联合静脉化疗对Dukes B或C期结肠癌患者存活的影响.方法：2000年3月至2005年3月期间Dukes B或C期结肠癌行根治术患者185例,随机分为三组：术后静脉化疗组61例、腹腔化疗组62例和腹腔化疗联合静脉化疗组62例.随访时间三年以上.应用log-rank检验和Cox比例风险回归分析比较三组存活率.结果：静脉化疗组、腹腔化疗组和腹腔化疗联合静脉化疗组三年生存率分别为58.8 %、79.7 %和76.8 %;腹腔化疗组和腹腔化疗联合静脉化疗组患者死亡风险均明显低于静脉化疗组（P〈0.05）,但腹腔化疗联合静脉化疗组与单纯腹腔化疗组相比无显著差异（P〉0.05）.多因素生存分析结果表明高龄、男性、DukesC期和单独应用静脉化疗均与增加的死亡风险显著相关（P〈0.05）.结论：Dukes B或C期结肠癌行根治术患者术后腹腔化疗能改善生存率,腹腔化疗联合静脉化疗并不优于单独应用腹腔化疗.

Objective： To compare effects of postoperative chemotherapy delivered by intraperitoneal and/or intravenous routes on the survival of patients with dukes stage B or C colon cancer. Methods： From April, 2000, through April, 2005, 185 patients with Dukes stage B or C colon cancer were randomly assigned： 68 patients to the intravenous chemotherapy, 69 patients to the intraperitoneal chemotherapy, and 69 patients to the combined chemotherapy. Survival rates were analyzed with the log--rank statistic and a Cox multivariable regression model. Results： At 3 years, the overall survival rates were separately 58.8 %, 79.7 % and 76.8 % in the intravenous chemotherapy group, the intraperitoneal chemotherapy group and the combined chemotherapy group. When compared with the intravenous chemotherapy group, the risk for death associated with either intraperitoneal chemotherapy or combined chemotherapy group was lower （P〈0.05）. There was no significant difference between the risk for death associated with intraperitoneal chemotherapy and that with combined chemotherapy （P〉0.05）. In the multivariable proportional hazard model, old age, male, Dukes stage C, and intravenous chemotherapy were statistically significantly associated with an increased risk of event or death （P〈0.05）. Conclusion： Postoperative intraperitoneal chemotherapy may improve survival rates of patients with Dukes stage Bor C colon cancer. The combined chemotherapy was no better than either single chemotherapy alone.