Effect of intra-operative chemotherapy with 5-fluorouracil and leucovorin on the survival of patients with colorectal cancer after radical surgery: a retrospective cohort study.
10.1097/CM9.0000000000002598
- Author:
Xuhua HU
1
;
Zhaoxu ZHENG
2
;
Jing HAN
3
;
Baokun LI
1
;
Ganlin GUO
1
;
Peiyuan GUO
1
;
Yang YANG
1
;
Daojuan LI
4
;
Yiwei YAN
5
;
Wenbo NIU
1
;
Chaoxi ZHOU
1
;
Zesong MENG
1
;
Jun FENG
1
;
Bin YU
1
;
Qian LIU
2
;
Guiying WANG
1
Author Information
1. The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050001, China.
2. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
3. Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050001, China.
4. Department of Cancer Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050001, China.
5. Department of Pediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050001, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Fluorouracil/therapeutic use*;
Leucovorin/therapeutic use*;
Colorectal Neoplasms/pathology*;
Retrospective Studies;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use*;
Proportional Hazards Models;
Prognosis
- From:
Chinese Medical Journal
2023;136(7):830-839
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:The effect of intra-operative chemotherapy (IOC) on the long-term survival of patients with colorectal cancer (CRC) remains unclear. In this study, we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.
METHODS:1820 patients were recruited, and 1263 received IOC and 557 did not. Clinical and demographic data were collected, including overall survival (OS), clinicopathological features, and treatment strategies. Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models. A regression model was developed to analyze the independent effects of IOC.
RESULTS:Proportional hazard regression analysis showed that IOC (hazard ratio [HR]=0.53, 95% confidence intervals [CI] [0.43, 0.65], P < 0.001) was a protective factor for the survival of patients. The mean overall survival time in IOC group was 82.50 (95% CI [80.52, 84.49]) months, and 71.21 (95% CI [67.92, 74.50]) months in non-IOC group. The OS in IOC-treated patients were significantly higher than non-IOC-treated patients ( P < 0.001, log-rank test). Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model (HR=0.53, 95% CI [0.43, 0.65], P < 0.001), model 2 (adjusted for age and gender, HR=0.52, 95% CI [0.43, 0.64], P < 0.001), and model 3 (adjusted for all factors, 95% CI 0.71 [0.55, 0.90], P = 0.006). The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II (HR = 0.46, 95% CI [0.31, 0.67]) or III disease (HR=0.59, 95% CI [0.45, 0.76]), regardless of pre-operative radiotherapy (HR=0.55, 95% CI [0.45, 0.68]) or pre-operative chemotherapy (HR=0.54, 95% CI [0.44, 0.66]).
CONCLUSIONS:IOC is an independent factor that influences the survival of CRC patients. It improved the OS of patients with stages II and III CRC after radical surgery.
TRIAL REGISTRATION:chictr.org.cn, ChiCTR 2100043775.
