Is Radical Surgery Alone Enough in T1-3N1a Colon Cancer?
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Background: Low lymphatic tumor burden would be associated with better prognosis, however, it still remained uncertain whether those clinically node negative colon cancer found to be pathologically diagnosed with node involvement could be a favorable subgroup in stage III disease and could be treated with radical surgery alone to avoid overtreatment. Methods: Eligible patients diagnosed with colon cancer without metastasis were recruited from Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016 using SEER*Stat 8.3.5 software (Surveillance Research Program, National Cancer Institute) and divided into two groups: surgery group (n = 3081) and surgery and adjuvant chemotherapy group (n = 4591). Overall survival (OS) and cause-specific survival (CSS) differences were assessed by Kaplan–Meier analysis, and survival differences were estimated with log-rank tests. Univariate and multivariate Cox proportional hazard regressions were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for colon cancer patients. Results: A total of 7672 pT1-3N1a colon cancer patients meeting with strict inclusion criteria of our analyses were recruited from 208751 colon cancer patients. The 5-year CSS rates of patients without adjuvant chemotherapy and patients with adjuvant chemotherapy were 80.0% and 90.7%, respectively. The receipt of adjuvant chemotherapy after the radical resection of the primary tumor was independently associated with 57.3% decreased risk of colon cancer-specific mortality compared with surgery alone (HR = 0.427, 95%CI = 0.370-0.492, P < 0.001, using surgery alone as the reference). Conclusions: Adjuvant chemotherapy was significantly associated with improved prognosis and radical surgery alone was not enough in colon cancer with very low lymphatic tumor burden.Keywords:
Radical surgery
Premedication
Hypersensitivity reaction
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背景・目的: oxaliplatin base の化学療法が大腸癌腹膜播種症例に与える影響について検討した。対象・方法: 2006 年1月～2012 年11 月の間に，腹膜播種陽性Stage IV 大腸癌と診断され，oxaliplatin base の化学療法を導入した49 例（oxaliplatin施行群）と，それ以前に5─FU 系の全身化学療法を施行した26 例（control 群）を対象。oxaliplatin 導入前後のoverall survival（OS）を比較。また，oxaliplatin 施行群のOS に関して臨床病理学的因子を共変量とし，単変量，多変量解析を行い，予後因子を検討した。結果: oxalplatin 施行群はcontrol 群より有意に生存期間が延長していた（中央値 20.5 か月 vs 11.7 か月，p＝0.04）。oxaliplatin 施行群におけるOS に対するfavorable factor として，70 歳以下（p＝0.03），原発巣切除（p＝0.02）が同定された。結語: oxaliplatin base の化学療法は大腸癌腹膜播種症例においても生存期間を改善させた。腹膜播種の程度に関係なく原発巣切除を70 歳以下の症例に行い，速やかにoxaliplatin base の化学療法を導入することが予後向上につながることが示唆された。
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Background Although most people with relapsing onset multiple sclerosis (R-MS) eventually transition to secondary progressive multiple sclerosis (SPMS), little is known about disability progression in SPMS. Methods All R-MS patients in the Cardiff MS registry were included. Cox proportional hazards regression was used to examine a) hazard of converting to SPMS and b) hazard of attaining EDSS 6.0 and 8.0 in SPMS. Results 1611 R-MS patients were included. Older age at MS onset (hazard ratio [HR] 1.02, 95%CI 1.01–1.03), male sex (HR 1.71, 95%CI 1.41–2.08), and residual disability after onset (HR 1.38, 95%CI 1.11–1.71) were asso- ciated with increased hazard of SPMS. Male sex (EDSS 6.0 HR 1.41 [1.04–1.90], EDSS 8.0 HR 1.75 [1.14–2.69]) and higher EDSS at SPMS onset (EDSS 6.0 HR 1.31 [1.17–1.46]; EDSS 8.0 HR 1.38 [1.19–1.61]) were associated with increased hazard of reaching disability milestones, while older age at SPMS was associated with a lower hazard of progression (EDSS 6.0 HR 0.94 [0.92–0.96]; EDSS 8.0: HR 0.92 [0.90–0.95]). Conclusions Different factors are associated with hazard of SPMS compared to hazard of disability progres- sion after SPMS onset. These data may be used to plan services, and provide a baseline for comparison for future interventional studies and has relevance for new treatments for SPMS RobertsonNP@cardiff.ac.uk
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OBJECTIVE To investigate the efficacy and safity of the domestic vs.imported oxaliplatin applied in advanced colon cancer.METHODS A total of 68 patients with advanced colon cancer were randomly divided into 2 groups : domestic oxaliplatin(50 mg) treatment group(the Ai Heng group,n=35) and imported oxaliplatin(50 mg) treatment group(Eloxatin group,n=33).All patients in both groups was adopted FOLFOX4 program(oxaliplatin combined with 5-fluorouracil and folinic acid).The adverse reactions and recent clinical efficacy were observed and a statistical analysis was conducted.RESULTS There were no significant difference in the recent clinical efficacy and chemotherapy-related adverse reactions between the two groups(P0.05).CONCLUSION Domestic oxaliplatin and the imported oxaliplatin are similar in anti-tumor efficacy and adverse reactions.Domestic oxaliplatin is safe and effective for advanced colon cancer.
Folinic acid
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Background: Significant efficacy of oxaliplatin-based chemotherapy has been demonstrated for advanced gastric cancer (AGC). However, the appropriate dose of oxaliplatin, and the efficacy and toxicity of administration of oxaliplatin subsequent to cisplatin therapy still remain unclear. Patients and Methods: In total, 55 patients with AGC that were scheduled to receive oxaliplatin-based chemotherapy were prospectively examined. Results: The median age was 67 years and oxaliplatin was administered to 39 (71%) patients as first-line and in 16 (29%) patients as second-line therapy. An initial dose of 130 or 100 mg/m2 of oxaliplatin was administered to 11 and 36 patients, respectively. The overall response rates (ORR) and median progression free survival (mPFS) were 86 and 33%, and 7.2 and 7.8 months, respectively. Compared to 100 mg/m2, the relative dose intensity was significantly lower and severe toxicity tended to increase with oxaliplatin at 130 mg/m2. A total of 10 patients (18%) had a prior cisplatin-based therapy. The ORR of the patients pretreated with cisplatin was 14% and the mPFS was 6.1 months. Conclusion: An initial oxaliplatin dose of 130 mg/m2 resulted in a good response, but tended to increase the risk of toxicity. Subsequent oxaliplatin-based therapy after cisplatin exhibited modest efficacy, especially in cases with cisplatin intolerance.
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瞄准：在回顾的案例系列分析在变形 colorectal 癌症调查导致 oxaliplatin 的严重过敏反应的反应(SAR ) 并且进行全身的文学评论。方法：在在高雄老手医院将军的从 2006 ～ 2011 的 6 年的经期期间，暴露于 oxaliplatin 相关的化疗的 412 个病人的一个总数回顾地被考察。关于威胁生活的 SAR 后面的 oxaliplatin 的相关英语语言的研究也在 MEDLINE 被考察吗？并且 PubMed？搜索。结果：八个病人(1.9% ， 412 个案例中的 8 个) 被识别。七个病人是成功的没有任何 sequelae，复活了，一个病人到期了。我们在病人 3 在五个病人和重新质问的 oxaliplatin 使用改变了化疗政体。与 66 个病人一起的 23 相关英语语言的研究被报导。接待的病人一 oxaliplatin 的 10 个周期中部(变化， 2 ～ 29 ) 。最普通的症状是呼吸的悲痛(60%) ，发烧(55%) ，和低血压(54%) 。三个致命的事件被报导(4.5%) 。66 个案例的十一个病人(16%) 被 oxaliplatin 重新质问。结论：SAR 必须重重地在收到 oxaliplatin 相关的化疗的病人被考虑，在特别 pretreated 病人。oxaliplatin 相关的 SAR 的机制，预言者，预防方法和管理上的进一步的研究被推荐。
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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oxaliplatin を含む化学療法により肝類洞障害が生じ，その結果，門脈圧が亢進し脾腫が生じる例があることが知られている。今回われわれは，oxaliplatin を含む化学療法により脾臓が増大し，oxaliplatin の休薬により縮小した大腸癌の2 例を報告する。なお脾臓体積の測定には医用画像処理ワークステーションZIOSTATION を用いた。ZIOSTATION 上で脾臓の3D 画像を作成し，その体積を測定した。症例1: 治療開始前137.82 mL であった脾臓はmFOLFOX6/bevacizumab による治療開始2 か月後160.96 mL に増大した。6 コース終了後神経障害のためoxaliplatin のみを休薬したところ151.58 mLに縮小した。神経障害改善後にoxaliplatin を再導入したところ脾臓は177.48 mL に増大したものの，再びoxaliplatin のみを休薬したところ158.52 mLに縮小した。症例2: 治療開始前105.84 mL であった脾臓はmFOLFOX6/bevacizumabによる治療開始10 か月後に228.54 mL に増大した。その後sLV5FU2/bevacizumab，さらにirinotecan 単剤へと移行したところ197.06 mL に縮小した。oxaliplatin 投与によって脾臓は増大するものの，oxaliplatin を休薬すれば脾臓の増大は可逆的である可能性がある。
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Aim: Cisplatin plus 5-fluorouracil (5-FU) or S-1 is a standard therapy for gastric cancer (GC). However, cisplatin is emetic and potentially nephrotoxic. Oxaliplatin may be less toxic, but few basic data are available for this setting. Here, we evaluated oxaliplatin for GC, by testing surgical specimens. Materials and Methods: We evaluated effects of oxaliplatin and 5-FU, alone and in combination, on surgical specimens from 11 patients with GC, using collagen gel droplet embedded culture drug tests. Results: Oxaliplatin was less efficacious than 5-FU, and its synergistic effect was less in tumors highly sensitive to 5-FU than in those with low sensitivity. Tumor differentiation and drug sensitivity were not correlated. Conclusion: Although oxaliplatin monotherapy had little effect on GC, we saw a limited synergistic effect of oxaliplatin with 5-FU in 5-FU-sensitive patients. Collagen gel droplet embedded culture drug tests may predict this synergistic effect, and help select candidates for this or other regimens.
Nephrotoxicity
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