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Medline ® Abstract for Reference 24

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

24
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Timing of adjuvant chemotherapy and its relation to survival among patients with stage III colon cancer.
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Bos AC, van Erning FN, van Gestel YR, Creemers GJ, Punt CJ, van Oijen MG, Lemmens VE
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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.
AD
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. Electronic address: a.bos@iknl.nl.
PMID