Evre II–III kolon kanserli 70 yaş ve üzeri hastalarda adjuvan kemoterapi süresi ve oksaliplatin kullanımına göre sağkalım sonuçları

Öz

Amaç: Evre II–III kolon kanseri olan yaşlı hastalarda adjuvan kemoterapi süresi ve rejim seçimi arasındaki optimal denge gerçek dünya pratiğinde halen net değildir. Bu çalışmada, evre II–III kolon kanseri olan yaşlı hastalarda adjuvan kemoterapi süresi ve oksaliplatin kullanımına göre sağkalım sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif kohort çalışması, 2015 ile 2023 yılları arasında küratif amaçlı cerrahi geçiren ve adjuvan kemoterapi alan, evre II–III kolon adenokarsinomlu ve 70 yaş ve üzeri hastaları içermiştir. Hastalar, adjuvan kemoterapi rejimine (oksaliplatin bazlı ve oksaliplatin içermeyen) ve tedavi süresine göre gruplandırılmıştır. Genel sağkalım (OS) ve hastalıksız sağkalım (DFS), Kaplan–Meier yöntemi ile analiz edilmiştir. Tüm nedenlere bağlı mortalite ve nüks ile ilişkili faktörler, çok değişkenli lojistik regresyon analizi kullanılarak değerlendirilmiştir. Bulgular: Toplam 65 hasta çalışmaya dâhil edilmiş olup, bunların 35’i oksaliplatin bazlı rejimler almıştır. Oksaliplatin ile tedavi edilen hastalar daha genç olup, evre III hastalık daha sık görülmüştür. Çok değişkenli analizde, >75 yaş (OR 3,45; %95 GA 1,16–10,21; p = 0,026) ve adjuvan kemoterapi süresinin <6 ay olması (OR 3,80; %95 GA 1,32–10,91; p = 0,013) tüm nedenlere bağlı mortalite ile bağımsız olarak ilişkili bulunmuştur. Oksaliplatin kullanımı, genel sağkalım (OR 1,36; %95 GA 0,45–4,11; p = 0,584) veya nüks riski ile bağımsız olarak ilişkili değildir. Kaplan–Meier analizleri, adjuvan kemoterapinin tam 6 ay tamamlandığı hastalarda genel sağkalımın anlamlı olarak daha iyi olduğunu göstermiş; buna karşın oksaliplatin kullanımına göre genel sağkalım veya hastalıksız sağkalım açısından anlamlı bir fark saptanmamıştır. Sonuç: Evre II–III kolon kanseri olan yaşlı hastalarda, adjuvan kemoterapinin 6 ay süreyle tamamlanması, floropirimidin bazlı rejimlere oksaliplatin eklenmesine kıyasla sağkalım ile daha güçlü bir ilişki göstermektedir. Bu bulgular, rutin klinik uygulamada özellikle tedavi toleransı sınırlı olan yaşlı hastalarda tedavi süresi ve sürekliliğinin rejim yoğunluğundan daha belirleyici olabileceğini düşündürmektedir.

Anahtar Kelimeler

• Kolon kanseri
• Adjuvan kemoterapi
• Oksaliplatin
• Sağkalım
• Yaşlı hastalar

Survival outcomes according to adjuvant chemotherapy duration and oxaliplatin use in patients aged 70 years and older with stage II–III colon cancer

Öz

Aim: The optimal balance between treatment duration and regimen selection in older patients with stage II–III colon cancer remains uncertain in real-world practice. This study aimed to evaluate survival outcomes according to adjuvant chemotherapy duration and oxaliplatin use in older patients with stage II–III colon cancer. Material and Methods: This retrospective cohort study included patients aged ≥70 years with stage II–III colon adenocarcinoma who underwent curative-intent surgery and received adjuvant chemotherapy between 2015 and 2023. Patients were grouped according to adjuvant chemotherapy regimen (oxaliplatin-based vs non-oxaliplatin) and treatment duration. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan–Meier method. Factors associated with survival outcomes were evaluated using Cox proportional hazards regression, and multivariable logistic regression analyses were additionally performed for all-cause mortality and recurrence. Results: A total of 65 patients were included, of whom 35 received oxaliplatin-based regimens. Patients treated with oxaliplatin were younger and more frequently had stage III disease. In multivariable analysis, age >75 years (OR 3.45, 95% CI 1.16–10.21; p = 0.026) and adjuvant chemotherapy duration <6 months (OR 3.80, 95% CI 1.32–10.91; p = 0.013) were independently associated with increased all-cause mortality. Oxaliplatin use was not independently associated with overall survival (OR 1.36, 95% CI 0.45–4.11; p = 0.584) or recurrence risk. Kaplan–Meier analyses demonstrated significantly improved overall survival among patients who completed a full 6-month course of adjuvant chemotherapy, whereas no significant differences in overall or disease-free survival were observed according to oxaliplatin use. Conclusion: In older patients with stage II–III colon cancer, completion of the planned duration of adjuvant chemotherapy appeared more impactful than regimen intensification with oxaliplatin in this real-world cohort. These findings highlight the importance of treatment continuity in routine clinical practice, particularly among older patients with limited tolerance to treatment.

Anahtar Kelimeler

• colon cancer
• adjuvant chemotherapy
• oxaliplatin
• survival
• older patients

Kaynakça

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