The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer: a national population-based cohort study

BackgroundBased on a prognostic scoring system (P score) proposed by us recently, this retrospective large population-based and propensity score-matched (PSM) study focused on predicting the survival benefit of adjuvant CT in stage II disease.MethodsPatients diagnosed with stage II colon cancer (N = 73397) were identified from the Surveillance, Epidemiology, and End Results database between January 1, 1988 and December 31, 2005 and divided into the CT and non-CT groups. PSM balanced the patient characteristics between the CT and non-CT groups.ResultsThe magnitude of CSS improvement among patients treated with adjuvant CT was significantly associated with the P score, score 8 [hazard ratio (HR) = 0.580, 95% confidence interval (CI) = 0.323–1.040, P = 0.067] was associated with a much higher increased CSS benefit among patients treated with adjuvant CT as compared to score 2* (*, including scores 0, 1, and 2; HR = 1.338, 95% CI = 1.089–1.644, P = 0.006).ConclusionsHigh P scores were demonstrated to be associated with superior survival benefit of adjuvant CT. Therapy decisions of adjuvant CT in stage II colon cancer could be tailored on the basis of tumor biology, patient characteristics and the P score.

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P-151 The impact of adjuvant chemotherapy regimens in stage II colon cancer (CC) patients

Annals of Oncology ◽

10.1016/j.annonc.2020.04.233 ◽

2020 ◽

Vol 31 ◽

pp. S139

Author(s):

S. Lobo-Martins ◽

M. Martins ◽

P. Semedo ◽

C. Alvim ◽

H. Luna Pais ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Stage Ii ◽

Stage Ii Colon Cancer ◽

The Impact

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Uptake of adjuvant chemotherapy for colon cancer in older and younger patients in the Irish population.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.478 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 478-478

Author(s):

Seamus Coyle ◽

Zia Rehman ◽

Chalen Lee ◽

Sandra Deady ◽

Harry Comber ◽

...

Keyword(s):

Colon Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Older Patients ◽

The Elderly ◽

Stage Ii ◽

Stage Iii ◽

Younger Patients ◽

The Impact

478 Background: Colon cancer is predominantly a disease of the elderly, with recent evidence supporting the use of adjuvant chemotherapy in the older population. However, it remains unclear to what degree such patients are receiving adjuvant therapy in clinical practice. We examined uptake of adjuvantchemotherapy and it’s impact on survival in older patients with stage II and stage III colon cancer in a national cohort. Methods: Using the National cancer Registry of Ireland, we identified 3,486 patients with stage II and III colon cancer who were treated with curative resection from 2004-2009. Clinopathological features and chemotherapy use were compared between those ≥70 years and those < 70 years. Results: A total of 2,026 patients with stage II disease were identified, 56% male and 60% ≥ 70 years. T3 tumors accounted for 81%, T4 19% and 89% were grade 2/3. Adjuvant chemotherapy was utilized in 10% and 40% of ≥ 70 and <70 years, respectively (p<0.0001). A benefit for chemotherapy over observation alone was seen in both the older [HR 0.36; 95% CI 0.36 – 0.68; p <0.0001] and younger patient groups [HR 0.43; 95% CI 0.2701 - 0.6881; p<0.0004]. Of 1,460 patients with stage III disease, 51% were ≥ 70 years, 54% male. 34% of older and 83% of younger patients received adjuvant therapy (p<0.0001). A similar magnitude of benefit from chemotherapy compared to observation was seen in patients ≥ 70 years [HR 0.30; 95% CI 0.29 - 0.45 ; p <0.0001] and <70 years [HR 0.22 95%CI 0.1 – 0.2; p<0.0001] with stage III disease. Conclusions: Adoption of adjuvant chemotherapy appears to be associated with significant survival benefit in older patients (age ≥ 70 years), however, is still underutilized in clinical practice. The impact of sociodemographic and clinicopathological features as potential drivers of treatment decisions in a cohort of this population will be reported.

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Patterns of Adjuvant Chemotherapy Use in a Population-Based Cohort of Patients With Resected Stage II or III Colon Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2011.35.0058 ◽

2011 ◽

Vol 29 (24) ◽

pp. 3255-3262 ◽

Cited By ~ 38

Author(s):

Thomas A. Abrams ◽

Rick Brightly ◽

Jianbin Mao ◽

Gregory Kirkner ◽

Jeffrey A. Meyerhardt ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Performance Status ◽

Population Based ◽

Stage Ii ◽

Patient Demographics ◽

Cancer Care Facilities ◽

Provider Characteristics ◽

Resected Stage

Purpose Previous studies have examined predictors for initiation of adjuvant chemotherapy in stages II and III colon cancer. However, little is known regarding the use of specific chemotherapy regimens or treatment duration. Patients and Methods We studied treatment records for 2,560 patients with stage II or III colon cancer who received adjuvant chemotherapy between January 2004 and April 2010 at US cancer care facilities participating in a nationwide, commercially available chemotherapy order entry system that captures patient demographics, stage, and details of chemotherapy treatment. Multivariate analyses of prospectively recorded patient and provider characteristics identified predictors of specific therapeutic approaches. Results The addition of oxaliplatin to fluoropyrimidine-based adjuvant therapy increased during the study period (P trend < .001), and this combination represented 78% and 90% of adjuvant chemotherapy in stage II or III disease, respectively, by 2007. Older patients, those with diminished performance status, and those treated in a private practice setting were significantly less likely to receive oxaliplatin. Thirty percent of patients discontinued adjuvant therapy after less than 3 months. Older age, oxaliplatin-containing therapy, and receipt of treatment from a physician with a low volume of patients were each independently associated with premature discontinuation. Six percent of patients received bevacizumab as part of their adjuvant regimen. Conclusion After 2004, oxaliplatin and fluoropyrimidine-based therapy rapidly became the predominant adjuvant treatment for both stage II and stage III colon cancer in this large US cohort. Both increasing patient age and lower volume of an oncologist's practice were associated with early termination of adjuvant therapy.

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Circulating tumor DNA guided adjuvant chemotherapy in stage II colon cancer (MEDOCC-CrEATE): study protocol for a trial within a cohort study

BMC Cancer ◽

10.1186/s12885-020-07252-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

S. J. Schraa ◽

◽

K. L. van Rooijen ◽

D. E. W. van der Kruijssen ◽

C. Rubio Alarcón ◽

...

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

Adjuvant Chemotherapy ◽

Study Protocol ◽

Circulating Tumor Dna ◽

Stage Ii ◽

Stage Ii Colon Cancer ◽

Tumor Dna

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A retrospective analysis on the impact of preoperative neutrophil to lymphocyte ratio in stage II colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.794 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 794-794

Author(s):

Deepna Jaiswal ◽

Suparna Mantha ◽

Lucas Wong ◽

Luis Seija ◽

Yolanda Munoz

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Critical Role ◽

Univariate Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Stage Ii ◽

Lymphocyte Ratio ◽

Stage Ii Colon Cancer ◽

The Impact

794 Background: Inflammation has a critical role in tumor genesis and progression of cancer. The neutrophil to lymphocyte ratio (NLR) is an indication of balance between the immune systems pro and defense mechanism against cancer. Elevated NLR is of interest in many cancers, including colon cancer. Although surgery is the mainstay of treatment for early stage colon cancer, adjuvant chemotherapy for stage II colon cancer has remained debatable. We proposed to study the impact of the NLR in patients with stage II colon cancer and to identify high risk patients who would benefit from adjuvant chemotherapy. Methods: Three hundred and eighty patients diagnosed with Stage II colon cancer at our institution were included in this retrospective study. Kaplan-Meir curves and multivariate Cox-regression analyses were calculated for overall survival. Results: Univariate analysis showed NLR was not statistically significant as predictor of mortality (p-value=0.0857). However, after adjusting for recurrence, chemotherapy, age, white blood cell count, the NLR was predictive for survival, with a hazard ratio of 1.05 and 95% confidence interval of (1.006 - 1.1). Recurrence and age were also significant predictors of survival (p-values of <0.0001 for both), and HR of 3.1 (2.0 – 4.6) and 1.4 (1.2 – 1.5), respectively. Conclusions: The neutrophil to lymphocyte ratio might be an independent prognostic marker for overall survival in stage II colon cancer patients. Given the retrospective nature of our study, further studies are indicated to confirm our findings.

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Association of delayed commencement of adjuvant chemotherapy (AC) with inferior survival in colon cancer patients with stage II and III diseases: A national population-based cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.669 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 669-669

Author(s):

Ik Yong Kim ◽

Young Wan Kim

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

Health Insurance ◽

Emergency Surgery ◽

Cancer Care ◽

Population Based ◽

Older Age ◽

Stage Ii ◽

Chemotherapy Group ◽

Colon Cancer Care

669 Background: To evaluate factors affecting the delay ( ≥ 8 weeks) of AC and the impact of chemotherapy delay on survival in patients with colon cancer(CC). Methods: The study cohort consisted of patients with stage II and III colon cancer, diagnosed between January 1, 2011 and December 31, 2012, who underwent curative resection and AC at all hospitals registered in the Korean Health Insurance Review and Assessment Service (HIRA). Detailed clinical data are from monitoring and evaluation of quality of colon cancer care. Results: Among 5355 patients, 154 (2.9%) received AC more than 8 weeks after surgery. Based on multivariate analysis, risk factors associated with AC delay ≥ 8 weeks were: older age [65 to 74 years (hazard ratio, HR = 1.48) and 75 years (HR = 1.69), p = 0.0354], medical aid status in health security system (HR = 1.76, p = 0.0345), emergency surgery (HR = 2.43, p = 0.0002), and chemotherapy with fluoropyrimidine (HR = 1.49, p = 0.0373). Independent prognostic factors for inferior OS included AC delay ≥ 8 weeks (HR = 1.49, p = 0.0365), older age [65 to 74 years (HR = 1.94) and 75 years (HR = 3.41), p < 0.0001], TNM III stage (HR = 2.46, p < 0.0001), emergency surgery (HR = 1.89, p < 0.0001), ASA score with 3 or higher (HR = 1.50, p < 0.0001), and higher transfusion amount (HR = 1.09, p = 0.0392). OS rates in patients with stage II / III CCs according to delay of AC using 8 weeks cutoff showed inferior OS in the delayed chemotherapy group (p = 0.008).Detailed OS rates were 97.81% at 1 year, 93.77% at 2 year, 89.62% at 3 year, and 85.79% at 4 year in the chemotherapy group within 8weeks. In the delayed chemotherapy group ≥ 8 weeks, OS rates were 96.1% at 1 year, 87.66% at 2 year, 80.98% at 3 year, and 80.2% at 4 year. Conclusions: This national population-based cohort study shows that delayed commencement of AC, defined as ≥ 8 weeks, is associated with inferior OS in CC patients with stage II / III. To reduce the proportion of patients receiving delayed AC, multidimensional aspects such as health insurance status or age should be considered. Based on our results, the time of commencement of chemotherapy can be incorporated as another quality indicator for colon cancer care.

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Use of Adjuvant Chemotherapy and Radiation Therapy for Colorectal Cancer in a Population-Based Cohort

Journal of Clinical Oncology ◽

10.1200/jco.2003.06.178 ◽

2003 ◽

Vol 21 (7) ◽

pp. 1293-1300 ◽

Cited By ~ 219

Author(s):

John Z. Ayanian ◽

Alan M. Zaslavsky ◽

Charles S. Fuchs ◽

Edward Guadagnoli ◽

Cynthia M. Creech ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Radiation Therapy ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Population Based ◽

Stage Ii ◽

Stage Iii Colon Cancer ◽

Adjuvant Therapies

Purpose: Randomized trials have demonstrated that adjuvant chemotherapy improves survival for patients with stage III colon cancer and that chemotherapy combined with radiation therapy improves survival for patients with stage II or III rectal cancer. This population-based study was designed to assess use of these treatments in clinical practice. Patients and Methods: From the California Cancer Registry, we identified all patients diagnosed during 1996 to 1997 with stage III colon cancer (n = 1,422) and stage II or III rectal cancer (n = 534) in 22 northern California counties. To supplement registry data on adjuvant therapies and ascertain reasons they were not used, we surveyed physicians or reviewed office records for 1,449 patients (74%). Results: Chemotherapy rates varied widely by age from 88% (age < 55 years) to 11% (age ≥ 85 years), and radiation therapy varied similarly. Adjusting for demographic, clinical, and hospital characteristics, chemotherapy was used less often among older and unmarried patients, and radiation therapy was used less often among older patients, black patients, and those initially treated in low-volume hospitals. Adjusted rates of chemotherapy varied significantly (P < .01) among individual hospitals: 79% and 51%, respectively, at one SD above and below average (67%). Physicians’ reasons for not providing adjuvant therapy included patient refusal (30% for chemotherapy, 22% for radiation therapy), comorbid illness (22% and 14%, respectively), or lack of clinical indication (22% and 45%, respectively). Conclusion: Use of adjuvant therapy for colorectal cancer varies substantially by age, race, marital status, hospital volume, and individual hospital, indicating opportunities to improve care. With enhanced data on adjuvant therapies, population-based registries could become a valuable resource for monitoring the quality of cancer care.

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The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy: a population-based cohort study

Diseases of the Esophagus ◽

10.1093/dote/doz079 ◽

2019 ◽

Vol 33 (6) ◽

Author(s):

Alfred Adiamah ◽

Lu Ban ◽

Joe West ◽

David J Humes

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Venous Thromboembolism ◽

Adjuvant Chemotherapy ◽

Cumulative Incidence ◽

Population Based ◽

Risk Of Death ◽

Increased Risk ◽

Esophagogastric Cancer ◽

The Impact

SUMMARY To define the incidence of postoperative venous thromboembolism (VTE) and effects of chemotherapy in a population undergoing surgery for esophagogastric cancer. This population-based cohort study used linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data from England to identify subjects undergoing esophageal or gastric cancer surgery between 1997 and 2014. Exposures included age, comorbidity, smoking, body mass index, and chemotherapy. Crude rates and adjusted hazard ratios (HRs) were calculated for rate of first postoperative VTE using Cox regression models. The cumulative incidence of VTE at 1 and 6 months was estimated accounting for the competing risk of death from any cause. Of the 2,452 patients identified, 1,012 underwent gastrectomy (41.3%) and 1,440 esophagectomy (58.7%). Risk of VTE was highest in the first month, with absolute VTE rates of 114 per 1,000 person-years (95% CI 59.32–219.10) following gastrectomy and 172.73 per 1,000 person-years (95% CI 111.44–267.74) following esophagectomy. Neoadjuvant and adjuvant chemotherapy was associated with a six-fold increased risk of VTE following gastrectomy, HR 6.19 (95% CI 2.49–15.38). Cumulative incidence estimates of VTE at 6 months following gastrectomy in patients receiving no chemotherapy was 1.90% and esophagectomy 2.21%. However, in those receiving both neoadjuvant and adjuvant chemotherapy, cumulative incidence following gastrectomy was 10.47% and esophagectomy, 3.9%. VTE rates are especially high in the first month following surgery for esophageal and gastric cancer. The cumulative incidence of VTE at 6 months is highest in patients treated with chemotherapy. In this category of patients, targeted VTE prophylaxis may prove beneficial during chemotherapy treatment.

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