临床肿瘤学杂志

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奥沙利铂联合卡培他滨一线治疗结直肠癌根治术后复发患者的分类及回归树分析

胡江鸿1,倪国华2   

  1. 1 212300 江苏丹阳 丹阳市人民医院消化科 2 212300 丹阳市人民医院肿瘤科
  • 收稿日期:2011-12-12 修回日期:2012-03-07 出版日期:2012-07-31 发布日期:2012-07-31

Classification and regression tree analysis of capecitabine combined with oxaliplatin as the first-line therapy in metastatic colorectal cancer patients

HU Jiang-hong, NI Guo-hua   

  1. Department of Gastroenterology,Danyang People's Hospital,Danyang 212300,China
  • Received:2011-12-12 Revised:2012-03-07 Online:2012-07-31 Published:2012-07-31

摘要: 目的 探讨奥沙利铂(L-OHP)联合卡培他滨(CAP)一线治疗转移性结直肠癌(mCRC)临床疗效的预测因素及其相关性。方法 2006年3月至2010年12月共80例mCRC患者采用L-OHP联合CAP方案一线治疗,具体为:L-OHP 130mg/m2静滴2h,d1;CAP 2000mg/m2 分2次口服,d2~d15,21天为1周期。采用分类及回归树(CART)分析该方案的客观疗效和无进展生存时间(PFS)的预测因素。结果 80例mCRC患者共完成化疗368个周期,平均4.6个周期。全组均可评价疗效,获CR 12例,PR 25例,SD 27例,PD 16例,有效率(RR)为46.2%,中位PFS为9.6个月(95%CI:8.2~11.0个月)。客观疗效的CART分析将组织分化情况作为第一级划分位点,术后肝转移和无瘤间期作为次级划分位点,逐级获得4个终末亚组,其中高、中分化且无瘤间期>12个月组的RR最高,为77.8%,低、未分化且肝转移组最低,仅为8.0%。 PFS的CART分析将客观疗效作为第一级划分位点,术后肝转移作为次级划分位点,逐级获得3个终末亚组,其中获有效组的PFS均数最大,为11.1个月,未获有效且术后肝转移组最小,仅为80个月;经Log-rank检验显示,获有效组的中位PFS优于其他两组(P<0.05)。结论 L-OHP联合CAP一线治疗mCRC的客观疗效可能与患者术后是否肝转移和无瘤间期长短有关,其PFS则与客观疗效和术后肝转移关系密切,精确的临床疗效关联预测值得深入探讨。

Abstract: Objective To explore factors forecasting clinical efficacy of oxaliplatin(L-OHP)combined with capecitabine(CAP) as the firstline therapy for metastatic colorectal cancer(mCRC) and their correlation. Methods From March 2006 to December 2010,80 mCRC patients were treated by L-OHP combined with CAP(CAP 1000mg/m2,d2-d15;L-OHP 130mg/m2,d1. Twenty-one days was a cycle). Classification and regression tree(CART)method was used to analyze the factors affecting objective response and predicting progressing-free survival(PFS).Results There were 368 cycles of chemotherapy in 80 mCRC patients(average 4-6 cycles). Twelve patients achieved complete remission,25 cases partial response,27 cases stable disease and 16 cases progressive disease. The response rate was 46.2% and the median PFS was 9.6 months(95%CI:8.2-11.0 months),which were evaluated according to RECIST 1.0 criteria or follow-up. Through CART analysis,objective response and histological differentiation were first nodes,tumor-free interval and liver metastasis were second nodes,and there were four end subgroups. Response rate of high,and median differentiation with liver metastasis subgroup was the highest(77.8%);low differentiation and undifferentiation with live metastasis subgroup was the lowest(8.0%). The CART analysis of PFS showed that objective response was the first node and liver metastasis was the second node,and there were three end subgroups. The mean PFS of response rate subgroup was longest(11.1 months);non response rate with liver metastasis subgroup was shortest(8.0 months). There was a significant difference between response rate subgroup and non response rate with or without liver metastasis subgroup by Log-rank test(P<005). Conclusion Objective response of L-OHP combined with CAP regimen as the first-line therapy in mCRC may be relevant to tumor-free interval and liver metastasis,while PFS of them may be relevant to objective response and liver metastasis. More accurate forecast results are still worth discussing.

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