| Objective: Colorectal cancer is one of the most common malignant tumors in the world.According to the Global Cancer Database,there were more than 1.8 million new colorectal cancer cases and 881000 deaths worldwide in 2018.The incidence of colorectal cancer in the world ranked third in all cancer incidence.The death rate of colorectal cancer ranked second and is the second most common cancer death rate over all world.In China,the incidence of colorectal cancer is also on the rise,now the incidence has risen to the third place.In the eastern part of China,its incidence rate is 10.36% and it ranked second in all cancers,which is far higher than its 6.1% average rate in the world.There are also significant differences in the incidence of colon cancer and rectal cancer.Among the more than 1.8 million new colorectal cancer cases worldwide in 2018,more than 109 million cases were colon cancer cases,as much as 60.9%.It can be seen that colon cancer accounts for a large proportion of colorectal cancer.However,the effect of radiotherapy and neoadjuvant therapy on colon cancer,especially ?-? stage colon cancer,is not satisfactory.At present,the main treatment method of ?-? stage colon cancer is radical surgery adjuvant postoperative chemotherapy.In NCCN guidelines for colon cancer,? stage colon cancer without high risk factors is recommended for postoperative observation or 5-FU chemotherapy,and 5-FU or FOLFOX or observation is recommended for ? stage colon cancer patients with high risk factors.For ? stage colon cancer,FOLFOX or 5-FU chemotherapy is recommended as the choice after operation.5-FU can also be used as a single drug.Among them,the use of oxaliplatin should be very cautious.The current belief should be emphasized that patients with stage ? colon cancer or colon cancer over 70 years of age were not proven to benefit from additional oxaliplatin use during 5-FU treatment.Therefore,the indication of oxaliplatin is not completely clear.With the wide use of oxaliplatin and other platinum drugs in chemotherapy,it not only brings the survival benefits,but also the side effects for all patients.The high incidence of side effects of platinum drugs affects the quality of life of patients,which cannot be ignored.Therefore,it is important to use oxaliplatin carefully and correctly and to determine which patients can get the best results from oxaliplatin therapy.The biological behavior,tumor classification,tumor staging and tumor grading are botht important indicators to evaluate tumor occurrence,development and prognosis.Nowadays,with the revolutionary development of medical technology and life science,tumor targeted therapy and individualized therapy have become the new research direction of tumor therapy.Traditional tumor classification,tumor staging and tumor grading have also been given more clinical significance and value.Especially,the histological classification of tumor is of high clinical value,which provides more accurate biological information for individual treatment of many tumors and guides the formulation of individualized treatment scheme.Today,histological classification has played a key role in the selection of treatment options in many tumors.For example,chemotherapy with cisplatin plus gemcitabine is more effective in squamous cell carcinoma of the lung,while in patients with lung adenocarcinoma or large cell lung cancer,cisplatin plus pemetrixide has better efficacy and reduced toxicity.In ovarian cancer,the chemotherapy regimen for each histological classification of tumor is different,such as carboplatin /isocyclophosphamide for carcinosarcoma,Paclitaxel / cisplatin for clear cell carcinoma,and capecitabine / oxaliplatin for mucoma.Paclitaxel / carboplatin is recommended for malignant cord stromal tumors.In contrast,the World Health Organization introduced histological classification as a classification system for colorectal cancer as early as 1979.However,faced with these histological classification,except for the poor prognosis of signet-ring cell carcinoma and insensitivity to radiotherapy and chemotherapy,the histological classification of colon cancer does not seem to play a role in the treatment.How to effectively use this histological classification to assist clinical practice has not been decided.Therefore,the purpose of this study is to explore whether there is a difference in the efficacy of chemotherapy between these two histological classification(adenocarcinoma VS mucinous adenocarcinoma)under various chemotherapy regimens.In view of the incomplete indications of oxaliplatin,we compared the prognosis of(FOLFOX)between mucinous adenocarcinoma and adenocarcinoma in non-chemotherapy group,5-FU group and FOLFOX group.Materials and methods: This study was based on the National Cancer Institute database on surveillance,epidemiology,prognosis,and health insurance(SEER-Medicare).51200 cases of colon cancer were selected from the original database by data preprocessing with strict criteria.Postoperative chemotherapy was divided into three groups(non-chemotherapy group,5-FU group and FOLFOX group).The single factor survival analysis was carried out with log-rank test of SPSS 20.0 software,and the Kaplan-Meier survival curve was drawn.The tendency score matching method was used to reduce the bias caused by hybrid variables.At the same time,the COX regression analysis of SPSS 20.0 software is used to carry out multivariate survival analysis,and the proportional risk model of COX is established.STATA 14.0 software was used to analyze the interaction between 5-FU single drug or FOLFOX and histological classification variables(adenocarcinoma or mucinous adenocarcinoma).Results: For low risk stage ? colon cancer,we compared the survival rate between the non-chemotherapy group and the 5-FU group in adenocarcinoma and mucinous adenocarcinoma respectively.There was no difference in survival between the two groups(P=0.629,P=0.387).There was no difference in survival between 5-FU group and FOLFOX group compared with mucinous adenocarcinoma(P=0.179,P=0.346).For high risk ? stage colon cancer,we also compared the survival rate between non-chemotherapy group and 5-FU group.There was no difference in survival between adenocarcinoma and mucinous adenocarcinoma(P=0.961,P=0.754).At the same time,we compared the survival rates of 5-FU and FOLFOX groups.Significant survival difference was found in adenocarcinoma(P=0.004),but not in mucinous adenocarcinoma(P=0.690).For ? stage colon cancer,we compared the survival rate between non-chemotherapy group and 5-FU group.There were significant differences in survival between adenocarcinoma and mucinous adenocarcinoma(P<0.001,P<0.001).In addition,the survival rates of 5-FU and FOLFOX groups were compared.Significant difference was found in adenocarcinoma(P<0.001),but not in mucinous adenocarcinoma(P<0.300).In addition,COX multivariate analysis was performed in stage ? and ? adenocarcinoma and mucinous adenocarcinoma,respectively.It was found that chemotherapeutic variables existed as independent prognostic factors in stage ? and ? adenocarcinoma,while in stage ? and ? mucinous adenocarcinoma,chemotherapy variables did not enter COX model.Furthermore,the interaction between chemotherapeutic regimen variables and histological classification variables was found in stage ? colon cancer interaction analysis(P=0.040).Conclusions: For high risk ? and ? colon adenocarcinoma without neoadjuvant therapy,increasing oxaliplatin chemotherapy on the basis of postoperative 5-FU single drug chemotherapy can increase the long-term survival rate.For mucinous adenocarcinoma under the same conditions,postoperative oxaliplatin chemotherapy did not increase survival rate.Considering the side effects of oxaliplatin are common and serious and irreversible complications is easily caused.It is recommended that oxaliplatin should be used carefully as a chemotherapeutic drug after operation in mucinous adenocarcinoma. |
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