转移性结直肠癌一线化疗稳定与有效的患者无生存差异分析  

Zero difference in survival between stable disease and good response in patients with advanced colorectal cancer after first-line chemotherapy

作　　者：李聪[1] 骆卉妍[1] 王志强[1] 王风华[1] 张乐[2] 陈翠[1] 徐瑞华[1] 李宇红[1] 

机构地区：[1]中山大学肿瘤防治中心,华南肿瘤学国家重点实验室,广州市510060 [2]天津医科大学附属肿瘤医院消化肿瘤内科

出　　处：《中国肿瘤临床》2013年第11期652-656,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:旨在探讨转移性结直肠癌患者一线化疗后不同疗效分组的生存差异,以期更好地指导化疗方案的选择。方法:研究纳入了接受一线化疗的232例复发转移性结直肠癌患者,按化疗最佳疗效先后分为疾病未进展与疾病进展组,化疗有效与疾病稳定组,分别比较两组患者的生存差异,并分析影响总生存的独立预后因素。结果:全组患者中位总生存时间(mOS)为21.10个月,中位无进展生存时间(mPFS)为9.17个月。一线化疗疾病未进展组与进展组的mOS分别为23.57个月和10.67个月,mPFS分别为10.83个月和2.83个月,差异均有统计学意义(P<0.001)。疾病稳定组与化疗有效组的mOS分别为23.57个月和24.30个月,mPFS分别为10.57个月和10.87个月,差异均无统计学意义(P=0.935,P=0.985)。原发病灶是否根治性切除、病理分级、复发转移病灶局部处理、化疗后疾病进展情况是影响总生存的独立预后因素。结论:复发转移性结直肠癌患者接受一线化疗后,疾病进展时有必要更换化疗方案,而近期疗效获得稳定的患者则无需更换化疗方案。Objective： This study aimed to investigate the differences in survival between groups of patients with metastatic colorectal carcinoma （CRC） who achieved different effieiencies after first-line chemotherapy, and to optimize treatment strategies for CRC patients. Methods： A retrospective study involving the data of 232 recurrent and metastatic colorectal cancer patients who had completed first-line chemotherapy was performed. The cases were divided into the following four groups, namely, patients with or with- out progression of disease （PD） and those with effectual chemotherapy or stable disease （SD）. The median progression-free survival （mPFS） and median overall survival （mOS） in the two groups were compared and analyzed. Independent prognostic factors affecting survival were also compared. Results： The mOS and mPFS in all arms were 21.10 and 9.17 months, respectively. The mOS and mPFS of the arms with complete response （CR）, partial response （PR）, and SD were significantly longer than those of the PD arm （23.57 vs. 10.67 months; 10.83 vs. 2.83 months）. However, no significant differences between the CR/PR and SD arm were observed （mOS, 23.57 vs. 24.30 months; mPFS, 10.57 vs. 10.87 months）. Radical excision of the primary tumor, pathologic grading, treatment of recurrent and metastatic lesion, and disease control after first-line chemotherapy were independent prognostic factors of the overall survival. Con- clusion： Our data show that an immediate shift to the second-line regimen is needed by metastatic CRC patients with PD after first-line chemotherapy. By contrast, patients with SD can continue the first-line chemotherapeutic regime.

关 键 词：结直肠癌 化疗 疗效 生存 预后因素 

分 类 号：R735.3[医药卫生—肿瘤]