Abstract：
OBJECTIVE: Adjuvant capecitabine and oxaliplatin (CAPOX) therapy is standard strategy for colorectal cancer with risk of recurrence. Early dose reduction (EDR) of CAPOX therapy is commonly used in real-world practice. However, there is limited evidence regarding the effectiveness of CAPOX for patients who had EDR. Therefore, this study aimed to clarify the risks of EDR and its effect on long-term outcomes and body composition factors.
METHODS: Patients who received CAPOX therapy after radical surgery for colorectal cancer between June 2013 and December 2021 were included. EDR was defined as dose reduction within four courses of CAPOX therapy. Body composition factors were measured for 1 year following surgery to determine the EDR effects.
RESULTS: Eighty-four patients were included; 35 (42%) of them had EDR. The multivariate analysis revealed that underweight [odds ratio (OR)=4.95, 95% confidence interval (CI)=1.13-21.7, p=0.03] was a risk factor for EDR. Relapse-free survival (RFS) was significantly better in the non-EDR group (p=0.01). The 5-year RFS rates for the non-EDR and EDR groups were 88.7% and 65.4%, respectively. The multivariate analysis revealed that age >65 years [hazard ratio (HR)=3.97; 95% CI=1.16-13.62, p=0.03] and EDR (HR=7.62; 95% CI=1.71-33.91, p=0.005) were associated with poorer RFS. The 1-year body composition analysis revealed decreases in all factors in the EDR group.
CONCLUSIONS: Preoperative underweight status was associated with EDR, which resulted in decreased RFS and body composition factors when compared with the non-EDR group. Therefore, avoiding EDR and early nutritional intervention after EDR may improve outcomes.
METHODS: Patients who received CAPOX therapy after radical surgery for colorectal cancer between June 2013 and December 2021 were included. EDR was defined as dose reduction within four courses of CAPOX therapy. Body composition factors were measured for 1 year following surgery to determine the EDR effects.
RESULTS: Eighty-four patients were included; 35 (42%) of them had EDR. The multivariate analysis revealed that underweight [odds ratio (OR)=4.95, 95% confidence interval (CI)=1.13-21.7, p=0.03] was a risk factor for EDR. Relapse-free survival (RFS) was significantly better in the non-EDR group (p=0.01). The 5-year RFS rates for the non-EDR and EDR groups were 88.7% and 65.4%, respectively. The multivariate analysis revealed that age >65 years [hazard ratio (HR)=3.97; 95% CI=1.16-13.62, p=0.03] and EDR (HR=7.62; 95% CI=1.71-33.91, p=0.005) were associated with poorer RFS. The 1-year body composition analysis revealed decreases in all factors in the EDR group.
CONCLUSIONS: Preoperative underweight status was associated with EDR, which resulted in decreased RFS and body composition factors when compared with the non-EDR group. Therefore, avoiding EDR and early nutritional intervention after EDR may improve outcomes.
摘要：
目的：卡培他滨和奥沙利铂（CAPOX）辅助治疗是有复发风险的结直肠癌的标准治疗策略。CAPOX治疗的早期剂量减少（EDR）通常用于现实世界的实践。然而,关于CAPOX对EDR患者的有效性的证据有限.因此,本研究旨在阐明EDR的风险及其对长期结局和身体组成因素的影响.
方法：纳入2013年6月至2021年12月间结直肠癌根治术后接受CAPOX治疗的患者。EDR定义为CAPOX治疗四个疗程内的剂量减少。在手术后1年内测量身体成分因子以确定EDR效应。
结果：包括84例患者；其中35例（42％）患有EDR。多变量分析显示，体重不足[优势比（OR）=4.95，95％置信区间（CI）=1.13-21.7，p=0.03]是EDR的危险因素。无复发生存率(RFS)在非EDR组明显优于对照组(p=0.01)。非EDR和EDR组的5年RFS率分别为88.7%和65.4%,分别。多变量分析显示，年龄>65岁[风险比（HR）=3.97;95％CI=1.16-13.62，p=0.03]和EDR（HR=7.62;95％CI=1.71-33.91，p=0.005）与较差的RFS相关。1年的身体成分分析显示EDR组的所有因素都减少。
结论：术前体重不足与EDR相关，与非EDR组相比，RFS和身体成分因子降低。因此,避免EDR和EDR后的早期营养干预可能会改善结局.
方法：纳入2013年6月至2021年12月间结直肠癌根治术后接受CAPOX治疗的患者。EDR定义为CAPOX治疗四个疗程内的剂量减少。在手术后1年内测量身体成分因子以确定EDR效应。
结果：包括84例患者；其中35例（42％）患有EDR。多变量分析显示，体重不足[优势比（OR）=4.95，95％置信区间（CI）=1.13-21.7，p=0.03]是EDR的危险因素。无复发生存率(RFS)在非EDR组明显优于对照组(p=0.01)。非EDR和EDR组的5年RFS率分别为88.7%和65.4%,分别。多变量分析显示，年龄>65岁[风险比（HR）=3.97;95％CI=1.16-13.62，p=0.03]和EDR（HR=7.62;95％CI=1.71-33.91，p=0.005）与较差的RFS相关。1年的身体成分分析显示EDR组的所有因素都减少。
结论：术前体重不足与EDR相关，与非EDR组相比，RFS和身体成分因子降低。因此,避免EDR和EDR后的早期营养干预可能会改善结局.
