Adjuvant chemotherapy for t1 node-positive colon cancers provides significant survival benefit.

Published

Journal Article

BACKGROUND: Contemporary treatment of node-positive (N+) colon cancer consists of adjuvant chemotherapy; however, randomized data supporting this practice were derived from lesions T2 or greater. Minimal data exist regarding the use and need for adjuvant chemotherapy in T1N+ disease. OBJECTIVE: The aim of this study was to determine treatment trends and the effects of adjuvant chemotherapy on T1N+ colon cancers by using the National Cancer Database. DESIGN: This was a retrospective study. Baseline demographics, tumor, and cancer treatment characteristics were compared. Groups were matched on the propensity to receive chemotherapy. Adjusted long-term survival stratified by chemotherapy use was compared by using the Kaplan-Meier method with the log-rank test. Predictors of not receiving chemotherapy were identified by using a multivariable logistic regression model. SETTINGS: Data were collected from the National Cancer Database, which collects cancer data from over 1500 cancer centers. PATIENTS: We identified patients from 1998 to 2006 with T1N+ disease, excluding those with metastatic disease or previous cancer. Patients were stratified based on whether or not they received chemotherapy. MAIN OUTCOME MEASURES: The primary outcome measure of this study was long-term survival. RESULTS: Three thousand one hundred thirty-seven patients had T1N+ disease; 70.6% (n = 2216) received chemotherapy, and utilization significantly increased from 1998 to 2011 (p < 0.001). Unadjusted analysis revealed that patients treated with chemotherapy were statistically younger and healthier, and had shorter postoperative lengths of stay (all p < 0.001). Unadjusted 5-year survival was higher in patients receiving chemotherapy (87.9% vs 63.0% in patients with no chemotherapy; p < 0.001) and this persisted after propensity matching with (83.4% and 63.0% in patients with or without chemotherapy; p < 0.001). Only age (OR, 0.29; p < 0.001) predicted not receiving chemotherapy. LIMITATIONS: Limitations include potential selection bias as well as the inability to compare disease-free survival/recurrence. CONCLUSIONS: Adjuvant chemotherapy appears to significantly improve long-term survival in patients receiving chemotherapy in T1N+ disease. Thus, the use of chemotherapy in T1N+ disease is justified and provides a highly significant survival benefit.

Full Text

Duke Authors

Cited Authors

  • Ganapathi, AM; Speicher, PJ; Englum, BR; Castleberry, AW; Migaly, J; Hsu, DS; Mantyh, CR

Published Date

  • December 2014

Published In

Volume / Issue

  • 57 / 12

Start / End Page

  • 1341 - 1348

PubMed ID

  • 25379998

Pubmed Central ID

  • 25379998

Electronic International Standard Serial Number (EISSN)

  • 1530-0358

Digital Object Identifier (DOI)

  • 10.1097/DCR.0000000000000245

Language

  • eng

Conference Location

  • United States