Analysis Of The Efficacy Of Standardized Adjuvant Treatment For Phase â…¢ Colorectal Cancer

Background and objective:The preferred method of treatment for colorectal cancer is surgery combinedtherapy. Adjuvant therapy play an important role by eliminating micro-metastases toreduce the recurrence rate and increase the survival rate. Most studies showed thatstandardization of adjuvant therapy could significantly reduce the risk of colorectalcancer recurrence and mortality. In clinical practice, we found that there is a largenon-normative adjuvant therapy, so we designed this retrospective analysis, to analyzethe efficacy of standardized adjuvant therapy and to explore the factors that affect thedegree of standardization, in order to provide clinical evidence for the popularizationof standardized adjuvant therapy.The purpose of the present study was to investigate the clinical significance ofstandardized adjuvant therapy and analyze the factors affecting the degree ofstandardization, in order to provide a theoretical basis for further promoting thestandardization of adjuvant therapy carried out.Methods:We collected the patients data accepted for colorectal cancer surgery andfollow-up data completely with stage Ⅲwhich visited the First Hospital of JilinUniversity during the period of between2009and2011. Based on NCCN treatmentguidelines (Version2010) and Standard of diagnosis and treatment of colorectalcancer (2010, china), we divided into no adjuvant therapy group, non-standardizedadjuvant group and standardized adjuvant group, compared the three-year disease-freesurvival (DFS) and overall survival (OS). In subgroup analysis, we divided thepatients with XELOX or FOLFOX chemotherapy regimens into two months,2~4months (including four months) and4~6months (including6months, not contains four months) according to chemotherapy periods, and compared the three-yeardisease-free survival and overall survival. Meanwhile, we divided the lower colorectalcancer patients into no adjuvant therapy group, non-standardized chemotherapy group,non-standardized radiotherapy and chemotherapy group and standardizedradiotherapy and chemotherapy group, compared three-year disease-free survival(DFS) and overall survival (OS), the local recurrence and distant metastasis rateamong three groups were analyzed. Finally, treatment with no adjuvant therapy groupand non-standardized patients were followed up investigation to analyze the effect oftheir treatment compliance factors to determine the impact of standardized treatmentreasons.Results:1. Untill the end of January2015, a total of328cases of colorectal cancerpatients were enrolled,141cases of no adjuvant therapy group with a medianfollow-up time of37.4months,108cases of non-standardized adjuvant group with amedian follow-up time of39.8months,79cases of standardized adjuvant group witha median follow-up time of42.4months. The3-year DFS was50.2%,61.1%and73.4%in three groups, and the difference was significant (P<0.001). The3-year OSwas58.7%,67.3%and81%, and the difference was significant (P<0.001). Comparedwith no adjuvant therapy group (P=0.01) and non-standardized adjuvant therapygroup (P<0.001), there was a statistically significant difference in standardizedadjuvant therapy group in DFS and OS.2. One hundred and fifty-eight cases of patients were applied with FOLFOX orXELOX chemotherapy regimens, included27cases of2months group,52cases of2~4months group and79cases of4~6months group. The3-year DFS was48.1%,61.5%and73.4%, while the3-year OS was55.6%,65.4%and81%. The resultsshowed that, compared with2months group and2~4months group, there was astatistically significant difference in4~6months group in DFS, and the P values were0.023and0.005, the same as in OS, and the P value were0.008and0.006. However,there was no significant difference in2months group and2~4months group in DFS and OS, and the value were0.687and0.973.3. In medium and low colorectal cancer patients, there were44cases in noadjuvant therapy group,23cases in non-standardized chemotherapy group,25casesin non-standardized radiotherapy and chemotherapy group, and30cases instandardized radiotherapy and chemotherapy group. The3-year DFS was43.2%,47.8%,56%and73.3%in each group (P=0.005). The3-year OS was52.3%,52.2%,64%and83.3%(P=0.008). The local recurrence rate in each group respectively36.4%,21.7%,12%and6.7%, compared with no adjuvant therapy group, the P valueswere0.220,0.029,0.003. The3-year distant metastasis rate was47.7%,39.1%,32%and20%in each group, compared with no adjuvant therapy group, the P value was0.120,0.030and0.001. Local recurrence was most prevalent in the presacral region42.3%(11cases), anastomotic area26.9%(7cases), perineal19.2%(5cases), iliacartery lymph nodes11.5%(3cases). The distant metastasis was most prevalent inliver metastasis38.3%(17cases), peritoneal metastasis29.5%(13cases), lungmetastasis18.2%(8cases), bone metastases9.1%(4cases), adrenal metastasis2.3%(1case), brain metastases of2.3%(1case).4. The influence factors of standard treatment included the age factor (19.7%),patients I refuse (4.4%), disease conceal (17.3%), economic reasons (7.2%), medicaltreatment (8%), non-standard chemotherapy regimen (11.6%), non-standardized dose(3.6%), non-standardized chemotherapy treatment course (3.6%). In no adjuvanttherapy group, the age and disease conceal were the main factors which the proportionwere34.8%and30.5%. Non-standardized chemotherapy treatment course was mainfactor in non-standardized adjuvant therapy group, and the proportion was64.8%.Lack of standardized chemotherapy regimen and non-standardized treatment courseand dose mainly occurred in some grass-roots hospital, the proportion was21.3%,8.3%and39.8%. The main factors of non-standardized treatment course and dosewere the patient’s needs (21.5%), economic reasons (13.9%), technical level ofmedical workers (29.1%) and no tolerate adverse reactions (35.4%).Conclusion: 1. In patients with colorectal cancer, standardized adjuvant treatment couldimprove disease-free survival and overall survival rate, and could improve theprognosis.2. In the medium and lower colorectal cancer patients, Standardized concurrentradiotherapy and chemotherapy could significantly could reduce the risk of localrecurrence and distant metastasis of colorectal cancer patients and improve survivalbenefit of patients.3. The influence factors of standardized treatment included age factor, patientrefused, disease conceal, economic reasons, technical level of medical workers, lackof standardized chemotherapy regimen and non-standardized treatment course anddose. The age and disease conceal were the main factors in no adjuvant therapy group.In the non-standardized adjuvant group the main factor is lack of standardizedchemotherapy regimen.4. Standardized adjuvant therapy could make patients have a significantsurvival benefit, it was recommended to strengthen the disease clinician education,universal knowledge of colorectal cancer treatment, in order to improve long-termsurvival of patients.