Multimodality treatment has been the basic tenet in the treatment of advanced colorectal cancer (CRC) with the aim of improving prognoses.¹ In addition to complete surgical resection, adjuvant chemotherapy (AC) in resected CRC has been attracting increasing interest. Previous clinical trials showed that 5-fluorouracil (5-FU) based AC was effective for reducing recurrence and thereby contributed to longer overall survival (OS) in patients with stage III CRC.^2–6 Moreover, oxaliplatin-including AC further improved the long-term prognosis of stage III colon patients.^7–9 However, the efficacy of AC after curative resection for stage IV CRC has been debated, with conflicting reports of benefits. Several randomized trials on 5-FU-based AC failed to demonstrate any survival benefit in CRC patients who underwent the resection of liver metastases after curative resection.^10–12 On the other hand, a recent phase III randomized controlled trial (RCT) showed that oral tegafur/uracil and leucovorin significantly prolonged recurrence-free survival (RFS) in CRC patients with synchronous or metachronous liver-limited metastases after primary resection and hepatectomy.¹³ However, the trial did not prove an OS benefit by oral AC in this patient cohort.¹³ Moreover, the efficacy of AC after curative resection for CRC with synchronous metastases in various organs remains unclear because of the paucity of systematic studies.

中文翻译：

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辅助化疗改善可切除IV期结直肠癌的预后：使用逆治疗加权概率的比较研究

多模式治疗一直是晚期结直肠癌 (CRC) 治疗的基本原则，旨在改善预后。¹除了完全手术切除外，已切除的 CRC 中的辅助化疗 (AC) 已引起越来越多的关注。先前的临床试验表明，基于 5-氟尿嘧啶 (5-FU) 的 AC 可有效减少复发，从而有助于延长 III 期 CRC 患者的总生存期 (OS)。^2-6此外，包含奥沙利铂的 AC 进一步改善了 III 期结肠患者的长期预后。^7–9然而，对于 IV 期 CRC 根治性切除后 AC 的疗效一直存在争议，关于益处的报道相互矛盾。几项关于基于 5-FU 的 AC 的随机试验未能证明在根治性切除后接受肝转移切除术的 CRC 患者的任何生存获益。^10-12另一方面，最近的一项 III 期随机对照试验 (RCT) 表明，口服替加氟/尿嘧啶和亚叶酸可显着延长原发性切除术后同步或异时肝局限性转移的 CRC 患者的无复发生存期 (RFS)，并且肝切除术。¹³然而，该试验并未证明在该患者队列中口服 AC 对 OS 有益。¹³此外，由于缺乏系统研究，根治性切除术后各器官同时转移的 CRC 的疗效仍不清楚。