Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer:: Who benefits and by how much?

被引:793
作者
Gill, S
Loprinzi, CL
Sargent, DJ
Thomé, SD
Alberts, SR
Haller, DG
Benedetti, J
Francini, G
Shepherd, LE
Seitz, JF
Labianca, R
Chen, W
Cha, SS
Heldebrant, MP
Goldberg, RM
机构
[1] Mayo Clin & Mayo Fdn, Rochester, MN 55905 USA
[2] British Columbia Canc Agcy, Vancouver, BC V5Z 4E6, Canada
[3] Queens Univ, Canada Clin Trials Grp, Natl Canc Inst, Kingston, ON, Canada
[4] Univ Penn, Ctr Canc, Philadelphia, PA 19104 USA
[5] SW Oncol Grp, Ctr Stat, Seattle, WA USA
[6] Univ Siena, I-53100 Siena, Italy
[7] Osped Riuniti Bergamo, I-24100 Bergamo, Italy
[8] Univ Mediterranean, Marseilles & Federat Francophone Cancerol Digest, Dijon, France
[9] Univ N Carolina, Chapel Hill, NC USA
关键词
D O I
10.1200/JCO.2004.09.059
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Although it is well-established that fluorouracil- (FU-) based adjuvant therapy improves survival for patients with resected high-risk colon cancer, the magnitude of adjuvant therapy benefit across specific subgroups and for individual patients has been uncertain. Patients and Methods Using a pooled data set of 3,302 patients with stage II and III colon cancer from seven randomized trials comparing FU + leucovorin or FU + levamisole to surgery alone, we performed an analysis based on a Cox proportional hazards regression model. Treatment, age, sex, tumor location, T stage, nodal status, and grade were tested for both prognostic and predictive significance. Model derived estimates of 5-year disease-free survival and overall survival (OS) for surgery alone and surgery plus FU-based therapy were calculated for a range of patient subsets. Results Nodal status, T stage, and grade were the only prognostic factors independently significant for both disease-free survival and OS. Age was significant only for OS. In a multivariate analysis, adjuvant therapy showed a beneficial treatment effect across all subsets. Treatment benefits were consistent across sex, location, age, T-stage, and grade. A significant stage by treatment interaction was present, with treatment benefiting stage III patients to a greater degree than stage II patients. Conclusion Patients with high-risk resected colon cancer obtain benefit from FU-based therapy across subsets of age, sex, location, T stage, nodal status, and grade. Model estimates of survival stratified by T stage, nodal status, grade, and age are available at http://www.mayoclinic.com/calcs. This information may improve patients' and physicians' understanding of the potential benefits of adjuvant therapy. (C) 2004 by American Society of Clinical Oncology.
引用
收藏
页码:1797 / 1806
页数:10
相关论文
共 57 条
[1]   Prognostic value of thymidylate synthase, Ki-67, and p53 in patients with Dukes' B and C colon cancer:: A national cancer institute-national surgical adjuvant breast and bowel project collaborative study [J].
Allegra, CJ ;
Paik, S ;
Colangelo, LH ;
Parr, AL ;
Kirsch, I ;
Kim, G ;
Klein, P ;
Johnston, PG ;
Wolmark, N ;
Wieand, HS .
JOURNAL OF CLINICAL ONCOLOGY, 2003, 21 (02) :241-250
[2]  
Boland CR, 1998, CANCER RES, V58, P5248
[3]   Should Dukes' B patients receive adjuvant therapy? A statistical perspective [J].
Buyse, M ;
Piedbois, P .
SEMINARS IN ONCOLOGY, 2001, 28 (01) :20-24
[4]   INFORMATION AND PARTICIPATION PREFERENCES AMONG CANCER-PATIENTS [J].
CASSILETH, BR ;
ZUPKIS, RV ;
SUTTONSMITH, K ;
MARCH, V .
ANNALS OF INTERNAL MEDICINE, 1980, 92 (06) :832-836
[5]   A MULTIVARIATE-ANALYSIS OF CLINICAL AND PATHOLOGICAL VARIABLES IN PROGNOSIS AFTER RESECTION OF LARGE BOWEL-CANCER [J].
CHAPUIS, PH ;
DENT, OF ;
FISHER, R ;
NEWLAND, RC ;
PHEILS, MT ;
SMYTH, E ;
COLQUHOUN, K .
BRITISH JOURNAL OF SURGERY, 1985, 72 (09) :698-702
[6]  
COHEN AM, 1991, CANCER, V67, P1859, DOI 10.1002/1097-0142(19910401)67:7<1859::AID-CNCR2820670707>3.0.CO
[7]  
2-A
[8]  
COX DR, 1972, J R STAT SOC B, V34, P187
[9]  
Davison B J, 1995, Oncol Nurs Forum, V22, P1401
[10]   Information needs and decisional preferences in women with breast cancer [J].
Degner, LF ;
Kristjanson, LJ ;
Bowman, D ;
Sloan, JA ;
Carriere, KC ;
ONeil, J ;
Bilodeau, B ;
Watson, P ;
Mueller, B .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 277 (18) :1485-1492