| Objective: In vitro study had shown that serum uric acid(SUA)can affect the sensitivity of cancer cells to the chemotherapeutic agent 5-fluorouracil(5-FU).This study aimed to investigate the effects of SUA on patients with stage Ⅱ and stage Ⅲ who used 5-FU-based adjuvant chemotherapy after radical resection of colon cancer.Methods: A total of 181 patients who were pathologically diagnosed with stage Ⅱ and stage Ⅲ colon cancer and treated with radical surgery and 5-FU-based adjuvant chemotherapy were included in this retrospective study.Clinical pathological data such as age,sex,pathological type,TNM staging,high-risk factors,operation approaches,adjuvant chemotherapy,blood routine,tumor markers,albumin,serum uric acid,etc were collected.Following up the patient’s diagnosis and treatment,we recorded the patient’s adjuvant chemotherapy regimen,disease free survival(DFS)and overall survival time(OS).SPSS 23 and EXCEL 2007 were used for statistical analysis.Categorical variables were analyzed by chi-square test and were expressed as constituent ratio(%).Continuous variables were represented by median(interquartile range),and Mann-Whitney U test was used for comparison between groups.Survival analysis and survival curves were performed using Kaplan-Meier method and log-rank test;and univariate and multivariate Cox regression analyses were applied.Results: 1.Among the overall patients,the OS and DFS of the high SUA group were significantly lower than those of the normal SUA group(P=0.001 and 0.001,respectively);and the OS and DFS of low SUA group were also significantly lower than those of the normal SUA group(P=0.001 and 0.048,respectively).The 1-year OS of patients in the high SUA group(n=19)vs low SUA group(n=48)vs normal SUA group(n=114)was 94.7% vs 97.9% vs 99.1%;the 3-year OS was 84.2% vs 79.2% vs 95.6%,and the 5-year OS was 66.9% vs 72.9% vs 90.4%(P=0.001).The 1-year DFS was 84.2% vs 89.5% vs 96.5%;the 3-year DFS was 57.9% vs 76.3% vs 86.8%,and the 5-year DFS was 52.6% vs 71.6% vs 85.9%(P=0.002).2.Subgroup analysis based on clinicopathological staging showed that in 70 cases of stage Ⅱ group,the OS and DFS of the high SUA group were significantly lower than those of the normal SUA group(P=0.004 and 0.013,respectively).Compared with the normal SUA group,the OS and DFS of the low SUA group tended to be shortened(P=0.111 and 0.105,respectively).The 1-year OS of the high SUA group(n=8)vs the low SUA group(n=17)vs the normal SUA group(n=45)was 100% vs 100% vs 100%;the 3-year OS was 88.2% vs 100% vs 100%,and the 5-year OS was 76.5% vs 85.7% vs 100%(P=0.018).The 1-year DFS was 88.2% vs 100% vs 97.8%;the 3-year DFS was 70.6% vs 87.5% vs 95.6%,and the 5-year DFS was 70.6% vs 75.0% vs 93.3%(P=0.039).3.Among 111 patients in the stage Ⅲ group,the OS and DFS of the high SUA group were significantly lower than those of the normal SUA group(P=0.002 and 0.001,respectively).The OS of the low SUA group were significantly lower than those of the normal SUA group(P=0.037).Compared with the SUA group,the DFS of the low SUA group tended to be shortened(P=0.464).The 1-year OS of the high SUA group(n=11)vs the low SUA group(n=31)vs the normal SUA group(n=69)was 90.9% vs 96.8% vs 98.6%;the 3-year OS was 72.7% vs 80.6% vs 92.9%,and the 5-year OS was 53.0% vs 71.0% vs 84.1%(P=0.006);median OS: 82.3 months in the high SUA group,not reached in the low SUA group and normal SUA group.The 1-year DFS was 72.7% vs 90.1% vs 95.7%;the 3-year DFS was 36.4% vs 79.6% vs 81.2%,and the 5-year DFS was 36.4% vs 72.0% vs 81.2%(P=0.002);median DFS: 29.8 months in the high SUA group,not reached in the low SUA group and normal SUA group.4.According to the number of clinical chemotherapy courses,further subgroup analysis showed that in the 81 patients with sufficient course of treatment,the OS and DFS of the high SUA group were significantly lower than those of the normal SUA group(P=0.037 and 0.010,respectively).Compared with the normal SUA group,the OS and DFS of the SUA group tended to shorten(P=0.350 and 0.264,respectively).The 1-year OS of the high SUA group(n=6)vs the low SUA group(n=18)vs the normal SUA group(n=57)was 100% vs 94.4% vs 100%;the 3-year OS was 83.3% vs 94.4% vs 96.5%,and 5-year OS were 62.5% vs 83.3% vs 93.0%(P=0.106).The 1-year DFS was 100% vs 94.1% vs 98.2%;the 3-year DFS was 50.0% vs 88.2% vs 91.2%,and the 5-year DFS was 50.0% vs 76.5% vs 89.4%(P=0.037).The median DFS of the high SUA group was 29.8 months,which was not achieved in the low SUA group and the normal SUA group.5.Among the 115 included XELOX combined chemotherapy regimens,67 patients completed a full course of chemotherapy.The OS and DFS of the high SUA group were significantly lower than those of the normal SUA group(P=0.076 and 0.029,respectively).Compared with the normal SUA group,the OS and DFS of the low SUA group tended to be shortened(P=0.300 and 0.478,respectively).The 1-year OS of the high SUA group(n=6)vs the low SUA group(n=14)vs the normal SUA group(n=47)was 100% vs 92.9% vs 100%;the 3-year OS was 83.3% vs 92.9% vs 95.7%,and 5-year OS were 62.5% vs 78.6% vs 91.5%(P=0.175).The 1-year DFS was 100% vs 92.3% vs 97.9%;the 3-year DFS was 50.0% vs 84.6% vs 89.4%,and the 5-year DFS was 50.0% vs 76.9% vs 87.2%(P=0.100).The median DFS of the high SUA group was 29.8 months,which was not achieved in the low SUA group and the normal SUA group.6.Multivariate Cox regression analysis shows that normal SUA levels was identified as an independent predictor of longer OS(P=0.001,HR=0.195,95%CI,0.075~0.505)and DFS(P=0.004,HR=0.295,95%CI,0.130~0.672).Conclusions: 1.SUA level is an independent prognostic factor for DFS and OS in stage Ⅱ and Ⅲ colon cancer patients undergoing radical surgical treatment and 5-FU-based adjuvant chemotherapy.2.Among stage Ⅱ and stage Ⅲ colon cancer patients with adjuvant chemotherapy after radical surgery,the prognosis of the normal SUA group is significantly better than that of the high SUA group and the low SUA group.In stage Ⅱ patients,the prognosis of the normal SUA group is significantly better than that of the high SUA group,and tends to be better than that of the low SUA group.In stage Ⅲ patients,the prognosis of the normal SUA group is significantly better than that of the high and low SUA groups.3.In the sufficient course of treatment group,the prognosis of the normal SUA group is significantly better than that of the high SUA group,and tends to be better than that of the low SUA group.Among the patients who completed sufficient courses of XELOX adjuvant chemotherapy,the prognosis of the normal SUA group is also significantly better than that of the high SUA group,and tends to be better than that of the low SUA group.4.High SUA levels at baseline shortens OS and DFS in colon cancer patients who receives XELOX adjuvant chemotherapy after surgery. |
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