Survival Analysis Of Recto-sigmoid Cancer And Rectal Cancer、Colon Cancer And Third-line Therapy Of Colorectal Cancer

Objective:1Colorectal cancer is one of the most common malignant tumors inChina, ranked of the third in the incidence of cancer in the world.Recto-sigmoid cancer occurs in the junction of rectum and sigmoid colon andthe spiral mucosa. Malignant tumors in this site are not uncommom but rarelyreported in our country.This paper discusses survival differences andinfluencing factors of the recto-sigmoid cancer and rectal cancer, sigmoidcancer.2Advanced colorectal cancer and metastatic colorectal cancer failed inthe first and second line therapy has poor prognosis and survival rate.Atpresent,there is no uniform national regimen for third-line therapy.This paperfocuses on the efficacy of third-line therapeutic regimen and the prognosticdeterminants.Method:1We enrolled the clinical data and follow-up data of hospitalizationrecto-sigmoid cancer, sigmoid cancer, rectal cancer patients from January2008to December2012at the Fourth Hospital of Hebei MedicalUniversity.Via Stastical Software SPSS16.0,we did data analysis.We useddisease-free survival and progression-free survival for observed indicators;Kaplan-Meier was used to draw survival curves.We used Cox regressionmodel to do multi factor analysis.2We enrolled the clinical data and follow-up data of hospitalizationthird-line colorectal cancer patients from January2008to December2012atthe Fourth Hospital of Hebei Medical University.Via Stastical SoftwareSPSS16.0,we analyzed retrospectively the efficacy of third-line therapeuticregimen and the prognostic determinants. Kaplan-Meier was used to draw survival curves,Log-Rank test was used to univariate analysis and comparisonbetween the survival curves and Cox regression model used to multi factoranalysis.Consequence:1In the research of recto-sigmoid cancer, rectal cancer and sigmoidcancer,337patients had complete follow-up data.The median follow-up timewas44months (range3to91months).There were no significant difference ofdifferent parts in OS(P>0.05).2The median PFS of recto-sigmoid cancer was48months.The medianPFS of sigmoid cancer was63months. The median PFS of rectal cancer was29months. The median PFS of sigmoid cancer was superior to recto-sigmoidcancer and the median PFS of recto-sigmoid cancer was superior to rectalcancer(P <0.05).3In the research of recto-sigmoid cancer, rectal cancer and sigmoidcancer, Cox regression model showed age and tumor infiltration depth wereindependent predictors of PFS for different tumor locations(P <0.05).4In the research of the third-line therapy of colorectal patients,weenrolled105patients and the median follow-up time was32months(range2to65months).To the end of the research,27patients were alive.The median OSwas10months and one year survival rate was31.4percent.5Of the third-line therapeutic regimen,the median PFS of targetedtherapy was superior to chemotherapy alone(P<0.05).The median PFS ofcombined chemotherapy was superior to single agent chemotherapy(P<0.05).Of the combined chemotherapy,the median PFS of FOLFOX wassuperior to FOLFIRI and S-1combined with cisplatin(P<0.05).But othercombined chemotherapeutic regimen had no significant differences.6Of the third-line therapeutic regimen,the median OS of targeted therapywas superior to chemotherapy (P<0.05). The median OS of combinedchemotherapy was superior to single agent chemotherapy(P<0.05). Of thecombined chemotherapy,the median OS of XELOX and FOLFOX wassuperior to S-1combined with cisplatin(P<0.05).But other combined chemotherapeutic regimen had no significant differences.7The signal factor analysis of third-line therapeutic regimenshowed:intial treatment,the number of metastases,PS status,CEA level,livermetastasis,ascites in the initial of third-line therapy and first or second linedrugs might effect third-line OS(P<0.05);Sex,age,primary tumor site,staging,K-RAS status,CA-199level before third-line therapy had no significant effect.8Cox regression multiple factor analysis showed, the number ofmetastases,PS status in the initial of third-line therapy and intial treatmentwere the mian independent predictors on the third-line survival of metastaticcolorectal cancer patients.Conclusion:1The PFS of recto-sigmoid cancer was superior to rectal cancer andinferior to sigmoid cancer,but the OS had no difference.Age and tumorinfiltrating depth might effect PFS,but this conclusion requires further analysisof clinical trials.2Different third-line therapeutic regimens had different efficacy and weshould select according to different circumstances.Adjuvant therapy,the lessnumber of metastases,better PS status,the lower CEA level,no livermetastasis,no ascites in the intial of third-line therapy and three toxic drugsinvolved during the first or second line therapy might had better third-line OS.The number of metastases, PS status in the intial of third-line therapy andintial treatment were the mian independent predictors on the third-linesurvival of metastatic colorectal cancer patients.