TY - JOUR
T1 - Receipt of Adjuvant Chemotherapy in Stage II Colon Cancer and Overall Survival
T2 - A National Cancer Database Study
AU - Enofe, Nosayaba
AU - Morris, Andrew D.
AU - Liu, Yuan
AU - Liang, Wendi
AU - Wu, Christina S.
AU - Sullivan, Patrick S.
AU - Balch, Glen G.
AU - Staley, Charles A.
AU - Gillespie, Theresa W.
AU - Shaffer, Virginia O.
N1 - Funding Information:
This research was supported partly by the Biostatistics and Bioinformatics Shared Resource of the Emory University Winship Cancer Institute and National Institute of Health / National Cancer Institute , award number P30CA138292 . The National Institute of Health (NIH) was not involved in any part of this research including the study design, data obtaining/collection, analysis or interpretation, manuscript writing, and decision to submit the article for publication. The content and conduct of this research are the authors’ sole responsibility and do not reflect in anyway the official views of the NIH. Deidentified National Cancer Database participant use files were the source of data used to conduct this research study. The statistical methodology and analysis used in this research have not been verified by the American College of Surgeons and the Commission on Cancer, and investigators are solely responsible for the conclusions drawn from this research study.
Funding Information:
This research was supported partly by the Biostatistics and Bioinformatics Shared Resource of the Emory University Winship Cancer Institute and National Institute of Health/National Cancer Institute, award number P30CA138292. The National Institute of Health (NIH) was not involved in any part of this research including the study design, data obtaining/collection, analysis or interpretation, manuscript writing, and decision to submit the article for publication. The content and conduct of this research are the authors? sole responsibility and do not reflect in anyway the official views of the NIH. Deidentified National Cancer Database participant use files were the source of data used to conduct this research study. The statistical methodology and analysis used in this research have not been verified by the American College of Surgeons and the Commission on Cancer, and investigators are solely responsible for the conclusions drawn from this research study. Authors' contributions: N.E. drafted and revised this manuscript. A.M. Y.L. T.W.G. and V.O.S. conceptualized the design of this study. N.E. V.O.S. T.W.G. Y.L. and W.L. acquired, analyzed, and interpreted these data. N.E. A.M. Y.L. C.W. P.S.S. G.G.B. C.A.S. T.W.G. and V.O.S. were all substantially involved in the revision and final approval of this manuscript.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Background: There are variations in the use of adjuvant chemotherapy (AC) in stage II colon cancer (CRC). We sought to determine which patients received chemotherapy, what factors were associated with receipt of AC, and how this impacted overall survival. Methods: Using the National Cancer Database, patients with stage II CRC who underwent surgical resection were selected; patients who received radiation or neoadjuvant chemotherapy were excluded. High-risk features (HRFs) were defined as pathological tumor stage IV, positive surgical margins, and perineural or lymphovascular invasion. Multivariable and subgroup analysis with eight subgroups stratified in the presence of HRFs, age, and the Charlson-Deyo score was performed. Results: Of 77,739 patients identified with stage II CRC, 18.3% received AC. Younger, healthier patients with HRFs had the highest chemotherapy receipt rate (46.7%), whereas patients without HRFs, ≥ 75 y, and with the Charlson-Deyo score of 2+ had the lowest rate (2.1%). Community cancer centers were more likely to initiate AC (odds ratio = 1.24 P < 0.01) especially among healthy HRF-negative patients and younger patients. No significant racial differences in AC use were observed. AC was associated with improved overall survival in subgroups with HRFs (hazard ratio [HR]: 0.81 P < 0.001; HR: 0.75 P < 0.001; HR: 0.65 P = 0.03; HR: 0.55, P < 0.001) but not in patients without HRFs. Conclusions: AC receipt rates differed depending on patient age and type of institution delivering care. AC was associated with survival benefits only in patients with HRFs regardless of age. These findings are clinically relevant to inform appropriate use of AC in stage II CRC.
AB - Background: There are variations in the use of adjuvant chemotherapy (AC) in stage II colon cancer (CRC). We sought to determine which patients received chemotherapy, what factors were associated with receipt of AC, and how this impacted overall survival. Methods: Using the National Cancer Database, patients with stage II CRC who underwent surgical resection were selected; patients who received radiation or neoadjuvant chemotherapy were excluded. High-risk features (HRFs) were defined as pathological tumor stage IV, positive surgical margins, and perineural or lymphovascular invasion. Multivariable and subgroup analysis with eight subgroups stratified in the presence of HRFs, age, and the Charlson-Deyo score was performed. Results: Of 77,739 patients identified with stage II CRC, 18.3% received AC. Younger, healthier patients with HRFs had the highest chemotherapy receipt rate (46.7%), whereas patients without HRFs, ≥ 75 y, and with the Charlson-Deyo score of 2+ had the lowest rate (2.1%). Community cancer centers were more likely to initiate AC (odds ratio = 1.24 P < 0.01) especially among healthy HRF-negative patients and younger patients. No significant racial differences in AC use were observed. AC was associated with improved overall survival in subgroups with HRFs (hazard ratio [HR]: 0.81 P < 0.001; HR: 0.75 P < 0.001; HR: 0.65 P = 0.03; HR: 0.55, P < 0.001) but not in patients without HRFs. Conclusions: AC receipt rates differed depending on patient age and type of institution delivering care. AC was associated with survival benefits only in patients with HRFs regardless of age. These findings are clinically relevant to inform appropriate use of AC in stage II CRC.
KW - Adjuvant chemotherapy
KW - Colon cancer
KW - Colon cancer survival
KW - NCDB
KW - Oncology
KW - Overall survival
KW - Stage II colon cancer
KW - Surgical oncology
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U2 - 10.1016/j.jss.2020.02.016
DO - 10.1016/j.jss.2020.02.016
M3 - Article
C2 - 32244127
AN - SCOPUS:85082458714
SN - 0022-4804
VL - 252
SP - 69
EP - 79
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -