一线化疗剂量强度对晚期转移性结直肠癌患者预后的影响

Impact of dose intensity of first-line chemotherapy on prognosis of patients with metastatic colorectal cancer

目的:探讨一线化疗剂量强度对晚期转移性结直肠癌患者疾病控制率和总生存的影响。方法:回顾性分析2012年3月—2015年12月于天津医科大学肿瘤医院接受一线FOLFOX方案化疗的37例转移性结直肠癌患者的临床资料。根据患者化疗情况,分别以80%、75%及85%作为一线奥沙利铂相对剂量强度(relative dose intensity,RDI)、一线5-氟尿嘧啶RDI以及平均RDI(average RDI,ARDI)的分界值。单因素生存分析采用Kaplan-Meier法,并进行log-rank检验。多因素生存分析采用COX回归模型。结果:一线奥沙利铂RDI≥80%组、一线5-氟尿嘧啶RDI≥75%组以及ARDI≥85%组的DCR分别高于相应的一线奥沙利铂RDI<80%组、一线5-氟尿嘧啶RDI<75%组以及ARDI<85%组,但差异均无统计学意义(P值均>0.05)。单因素分析结果显示,年龄、后续手术治疗、后续除手术以外的化疗、一线奥沙利铂RDI、一线5-氟尿嘧啶RDI以及化疗前血清糖类抗原19-9是影响患者总生存的预后影响因素(P值均<0.05);而患者性别、美国东部肿瘤协作组体能状况(Eastern Cooperative Oncology Group performance status,ECOG PS)评分、化疗前并发症、原发部位、淋巴结转移、肝转移、腹膜转移、转移器官数目、ARDI、化疗前血清白蛋白水平和化疗前血清癌胚抗原水平对患者总生存无显著影响(P值均>0.05)。多因素分析结果显示,后续手术治疗、后续除手术以外的化疗和一线奥沙利铂RDI是影响患者总生存的独立预后因素(P值均<0.05)。结论:一线奥沙利铂RDI是影响转移性结直肠癌患者预后的独立因素,一线奥沙利铂RDI≥80%者的总生存获益更为显著,此为晚期结直肠癌的规范化疗提供了方向。

Objective： To explore the impact of dose intensity of first-line chemotherapy on disease control rate （DCR） and overall survival （OS） of patients with metastatic colorectal cancer （mCRC） Methods： The clinical data of 37 patients with mCRC from March 2012 to December 2015 were retrospectively analyzed. All of the patients received FOLFOX regimen as first-line chemotherapy in Tianjin Medical University Cancer Institute and Hospital. The values of 80%, 75% and 85% were respectively used as the cutoff points of relative dose intensity （RDI） of oxaliplatin, 5-fluorouracil and the average RDI （ARDI）. Kaplan-Meier method and log-rank test were used for univariate survival analysis and the COX proportional hazard regression model was used for multivariate survival analysis. Results： The DCRs of oxaliplatin RDI ≥80% group, 5-fluorouracil RDI ≥75% group and ARDI ≥85% group were respectively higher than those of oxaliplatin RDI 〈 80% group, 5-fluorouracil RDI 〈 75% group and ARDI 〈 85% group, respectively; but there were no statistically significant differences （all P 〉 0.05）. Kaplan-Meier univariate survival analysis showed that age, subsequent surgery, subsequent chemotherapy, first-line oxaliplatin RDI, first-line 5-fluorouracil RDI and serum carbohydrate antigen （CA） 19-9 level before chemotherapy had effects on OS of patients with mCRC （all P 〈 0.05）. Gender, Eastern Cooperative Oncology Group performance status （ECOG PS） score, complications before chemotherapy, primary location, lymph node metastasis, liver metastasis, peritoneum metastasis, number of metastatic sites, ARDI, serum albumin level before chemotherapy and serum carcino- embryonic antigen （CEA） level before chemotherapy had no effects on OS of mCRC patients （all P 〉 0.05）. COX multivariate analysis showed that subsequent surgery, subsequent chemotherapy and first-line oxaliplatin RDI were independent prognostic factors for OS （all P 〈 0.05） of mCRC patients. Conclusion： First-line oxaliplatin RDI is an independent prognostic factor for patients with mCRC. Patients who received first-line oxaliplatin RDI≥80% have better OS than those who received first-line oxaliplatin RDI 〈 80%. These findings throw light on the standardized chemotherapy for advanced colorectal cancer patients.