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Medline ® Abstract for Reference 16

of 'Adjuvant therapy for resected stage III (node-positive) colon cancer'

Timing of adjuvant chemotherapy and its relation to survival among patients with stage III colon cancer.
Bos AC, van Erning FN, van Gestel YR, Creemers GJ, Punt CJ, van Oijen MG, Lemmens VE
Eur J Cancer. 2015 Nov;51(17):2553-61. Epub 2015 Sep 7.
BACKGROUND: Currently available data suggest that delaying the start of adjuvant chemotherapy in colon cancer patients has a detrimental effect on survival. We analysed which factors impact on the timing of adjuvant chemotherapy and evaluated the influence on overall survival (OS).
PATIENTS AND METHODS: Stage III colon cancer patients who underwent resection and received adjuvant chemotherapy between 2008 and 2013 were selected from the Netherlands Cancer Registry. Timing of adjuvant chemotherapy was subdivided into:⩽4, 5-6, 7-8, 9-10, 11-12 and 13-16weeks post-surgery. Multivariable regressions were performed to assess the influence of several factors on the probability of starting treatment within 8weeks post-surgery and to evaluate the association of timing of adjuvant chemotherapy with 5-year OS.
RESULTS: 6620 patients received adjuvant chemotherapy, 14% commenced after 8weeks. Factors associated with starting treatment after 8weeks were older age (Odds ratio (OR) 65-74 versus<65years 1.3 (95% confidence interval (CI): 1.14-1.58); OR⩾75 versus<65years 1.6 (1.25-1.94)), emergency resection (OR 1.8 (1.41-2.32)), anastomotic leakage (OR 8.1 (6.14-10.62)), referral to another hospital for adjuvant chemotherapy (OR 1.9 (1.36-2.57)) and prolonged postoperative hospital admission (OR 4.7 (3.30-6.68)). Starting 5-8weeks post-surgery showed no decrease in OS compared to initiation within 4weeks (Hazard ratio (HR) 5-6weeks 0.9 (0.79-1.11); HR 7-8weeks 1.1 (0.91-1.30)). However, commencing beyond 8weeks was associated with decreased OS compared to initiation within 8weeks (HR 9-10weeks 1.4 (1.21-1.68); HR 11-12weeks 1.3 (1.06-1.59); HR 13-16weeks 1.7 (1.23-2.23)).
CONCLUSION: Our data support initiating adjuvant chemotherapy in stage III colon cancer patients within 8weeks post-surgery.
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. Electronic address: a.bos@iknl.nl.