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：一项使用治疗权重逆概率的比较研究


多学科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除了完全手术切除之外，CRC 切除后的辅助化疗 (AC) 也引起了越来越多的关注。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，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，IV 期 CRC 根治性切除后 AC 的疗效一直存在争议，其益处报道相互矛盾。几项基于 5-FU 的 AC 随机试验未能证明对根治性切除术后接受肝转移切除的 CRC 患者有任何生存益处。 ^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/尿嘧啶和甲酰四氢叶酸可显着延长原发切除术后同时或异时肝脏局限性转移的 CRC 患者的无复发生存期 (RFS)。肝切除术。 ¹³然而，该试验并未证明口服 AC 对该患者队列具有 OS 益处。 ¹³此外，由于缺乏系统研究，AC 治疗性切除后对多个器官同时转移的 CRC 的疗效仍不清楚。