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

Publication ,  Journal Article
Ganapathi, AM; Speicher, PJ; Englum, BR; Castleberry, AW; Migaly, J; Hsu, DS; Mantyh, CR
Published in: Dis Colon Rectum
December 2014

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.

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Published In

Dis Colon Rectum

DOI

EISSN

1530-0358

Publication Date

December 2014

Volume

57

Issue

12

Start / End Page

1341 / 1348

Location

United States

Related Subject Headings

  • United States
  • Survivors
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Prognosis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Male
  • Lymphatic Metastasis
 

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Ganapathi, A. M., Speicher, P. J., Englum, B. R., Castleberry, A. W., Migaly, J., Hsu, D. S., & Mantyh, C. R. (2014). Adjuvant chemotherapy for t1 node-positive colon cancers provides significant survival benefit. Dis Colon Rectum, 57(12), 1341–1348. https://doi.org/10.1097/DCR.0000000000000245
Ganapathi, Asvin M., Paul J. Speicher, Brian R. Englum, Anthony W. Castleberry, John Migaly, David S. Hsu, and Christopher R. Mantyh. “Adjuvant chemotherapy for t1 node-positive colon cancers provides significant survival benefit.Dis Colon Rectum 57, no. 12 (December 2014): 1341–48. https://doi.org/10.1097/DCR.0000000000000245.
Ganapathi AM, Speicher PJ, Englum BR, Castleberry AW, Migaly J, Hsu DS, et al. Adjuvant chemotherapy for t1 node-positive colon cancers provides significant survival benefit. Dis Colon Rectum. 2014 Dec;57(12):1341–8.
Ganapathi, Asvin M., et al. “Adjuvant chemotherapy for t1 node-positive colon cancers provides significant survival benefit.Dis Colon Rectum, vol. 57, no. 12, Dec. 2014, pp. 1341–48. Pubmed, doi:10.1097/DCR.0000000000000245.
Ganapathi AM, Speicher PJ, Englum BR, Castleberry AW, Migaly J, Hsu DS, Mantyh CR. Adjuvant chemotherapy for t1 node-positive colon cancers provides significant survival benefit. Dis Colon Rectum. 2014 Dec;57(12):1341–1348.

Published In

Dis Colon Rectum

DOI

EISSN

1530-0358

Publication Date

December 2014

Volume

57

Issue

12

Start / End Page

1341 / 1348

Location

United States

Related Subject Headings

  • United States
  • Survivors
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Prognosis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Male
  • Lymphatic Metastasis