Effect of intra-operative chemotherapy with 5-fluorouracil and leucovorin on the survival of patients with colorectal cancer after radical surgery: a retrospective cohort study

作     者：Xuhua Hu Zhaoxu Zheng Jing Han Baokun Li Ganlin Guo Peiyuan Guo Yang Yang Daojuan Li Yiwei Yan Wenbo Niu Chaoxi Zhou Zesong Meng Jun Feng Bin Yu Qian Liu Guiying Wang 

作者机构：The Second Department of General SurgeryThe Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China Department of Colorectal SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Medical OncologyThe Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China Department of Cancer InstituteThe Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China Department of PediatricsThe Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China Department of General SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei 050050China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2023年第136卷第7期

页      面：830-839页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Youth Science and Technology Project of Hebei Health Commission(No.20210029) Hebei Provincial Natural Science Foundation Precision Medicine Joint Project(No.H2020206485) Hebei Provincial Department of Science and Technology Key Project(No.206Z7705G) 

主　　题：Colorectal cancer Intra-operative chemotherapy Overall survival Retrospective cohort study Stage 

摘      要：Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.Methods:1820 patients were recruited,and 1263 received IOC and 557 did not.Clinical and demographic data were collected,including overall survival(OS),clinicopathological features,and treatment strategies.Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models.A regression model was developed to analyze the independent effects of IOC.Results:Proportional hazard regression analysis showed that IOC(hazard ratio[HR]=0.53,95%confidence intervals[CI][0.43,0.65],P0.001)was a protective factor for the survival of patients.The mean overall survival time in IOC group was 82.50(95%CI[80.52,84.49])months,and 71.21(95%CI[67.92,74.50])months in non-IOC group.The OS in IOC-treated patients were significantly higher than non-IOC-treated patients(P0.001,log-rank test).Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model(HR=0.53,95%CI[0.43,0.65],P0.001),model 2(adjusted for age and gender,HR=0.52,95%CI[0.43,0.64],P0.001),and model 3(adjusted for all factors,95%CI 0.71[0.55,0.90],P=0.006).The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II(HR=0.46,95%CI[0.31,0.67])or III disease(HR=0.59,95%CI[0.45,0.76]),regardless of pre-operative radiotherapy(HR=0.55,95%CI[0.45,0.68])or pre-operative chemotherapy(HR=0.54,95%CI[0.44,0.66]).Conclusions:IOC is an independent factor that influences the survival of CRC patients.It improved the OS of patients with stages II and III CRC after radical surgery.Trial registration:***,ChiCTR 2100043775.