Significance of postoperative adjuvant immunochemotherapy after curative resection of colorectal cancers: Association between host or tumor factors and survival.
We examined the relationship between host as well as tumor factors and postoperative survival rate in patients who received combination therapy of mitomycin C + fluoropyrimidine oral antineoplastics + protein-bound polysaccharide K (PSK) (MFP therapy) after curative resection of colorectal cancer. Markers that determine prognosis, such as preoperative humoral factors (complement 3 and 4), immunosuppressive acidic protein (IAP), lymphocyte transformation (cellular factors) induced by phytohemagglutinin (PHA), pokeweed mitogen (PWM), and PSK, and various tumor markers (CEA, CA19-9) were measured. For each parameter, patients were divided into a high-level and a low-level group according to a predetermined cut-off value, and survival rates were compared between the two groups. The host factors that determined prognosis were 1-month postoperative IAP level [IAP(1M)], preoperative PHA value, and preoperative CA19-9 level. The levels of IAP(1M) <740 microg/ml, preoperative PHA > or =210 (SI value), and preoperative CA19-9 <13 U/ml were associated with a favorable prognosis. When combined with the tumor factors, the prognosis was favorable in Dukes A+B cases with preoperative CA19-9 <13 U/ml, and in Dukes C cases with preoperative PHA > or =210 SI. By the Cox proportional hazard model analysis, among IAP, PHA and CA19-9, CA19-9 was the strongest host factor associated with the prognosis of MFP therapy.
Munemoto
Yoshinori
Y
Department of Surgery, Prefecture of Saiseikai Fukui Hospital, Fukui 918-8503, Japan. y-munemoto@fukui.saiseikai.or.jp
Iida
Yoshiro
Y
Abe
Jinro
J
Saito
Hideo
H
Fujisawa
Katsunori
K
Kasahara
Yoshiro
Y
Mitsui
Tsuyoshi
T
Asada
Yasuyuki
Y
Miura
Shouji
S
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D005260:Female; D006801:Humans; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D009363:Neoplasm Proteins / Q000378:metabolism; D010835:Phytohemagglutinins / Q000494:pharmacology; D011134:Polysaccharides / Q000008:administration & dosage / Q000627:therapeutic use; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use; D016019:Survival Analysis; D015996:Survival Rate
D014408:Biomarkers, Tumor; D003176:Complement C3; D003181:Complement C4; D009363:Neoplasm Proteins; D010835:Phytohemagglutinins; D011134:Polysaccharides; D011743:Pyrimidines; C030193:immunosuppressive acidic protein; D016685:Mitomycin; C029269:5-fluoropyrimidine