Beneficio de la quimioterapia adyuvante en pacientes con cáncer de colon: cohorte retrospectiva de un hospital clínico universitario

Febrero 2016

Art ículos de Investigaci ón 145 Rev Med Chile 2016; 144: 145-151 Beneficio de la quimioterapia adyuvante en pacientes con cáncer de colon: cohorte retrospectiva de un hospital clínico universitario Sebastián Mondaca1, Constanza Villalón2, José Luis Leal1, Álvaro Zúñiga2, Felipe Bellolio2, Oslando Padilla3,a, Silvia Palma1,b, Marcelo Garrido1, Bruno Nervi1 Benefit of adjuvant 5-fluorouracil based chemotherapy for colon cancer: a retrospective cohort study Background: Multiple clinical trials have demonstrated the benefits of adjuvant 5-fluorouracil-based chemotherapy for patients with resectable colon cancer (CC), especially in stage III. Aim: To describe the clinical characteristics of a cohort of CC patients treated at a single university hospital in Chile since 2002, and to investigate if chemotherapy had an effect on survival rates. Material and Methods: Review of a tumor registry of the hospital. Medical records of patients with CC treated between 2002 and 2012 were reviewed. Death certificates from the National Identification Service were used to determine mortality. Overall survival was described using the Kaplan-Meier method. A multivariate Cox proportional hazard regression model was also used. Results: A total of 370 patients were treated during the study period (202 in stage II and 168 in stage III). Adjuvant chemotherapy was administered to 22 and 70% of patients in stage II and III respectively. The median follow-up period was 4.6 years. The 5-year survival rate for stage II patients was 79% and there was no benefit observed with adjuvant chemotherapy. For stage III patients, the 5-year survival rate was 81% for patients who received adjuvant chemotherapy, compared to 56% for those who did not receive chemotherapy (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.15-0.56). The benefit of chemotherapy was found to persist after adjustment for other prognostic variables (HR: 0.47; 95% CI: 0.23-0.94).Conclusions: Patients with colon cancer in stage III who received adjuvant chemotherapy had a better overall survival. (Rev Med Chile 2016; 144: 145-151) Key words: Antineoplastic combined chemotherapy protocols; Chemotherapy, adjuvant; Colonic neoplasms; Fluorouracil. 1Departamento de Hematología y Oncología, Pontificia Universidad Católica de Chile, Santiago, Chile. 2Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile. 3Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile. aEstadístico. bEnfermera Universitaria. Recibido el 5 de junio de 2015, aceptado el 16 de noviembre de 2015. Correspondencia a: Bruno Nervi Departamento de Hematología y Oncología. Centro de Cáncer. Pontificia Universidad Católica de Chile. Diagonal Paraguay 319, Santiago, Chile. Código postal 8330032 Teléfonos: 2-3546919 Fax: 2-2472327 bnervi@med.puc.cl El cáncer de colon (CC) es la tercera neoplasia en frecuencia y la cuarta en mortalidad a nivel mundial1. A diferencia de lo que ocurre en países desarrollados, donde su mortalidad va en descenso2,3, en Chile habría una tendencia al alza en su mortalidad de 3,7 en el año 1990 a 6,3/100.000 en el año 20044. Este hecho puede ser explicado por múltiples hipótesis, destacando cambios en el estilo de vida de la población, falta de acceso a programas de tamizaje en población asintomática y diferencias en las oportunidades de tratamiento de esta enfermedad.


Febrero 2016
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