Utilization and impact of adjuvant chemotherapy among patients with resected stage II colon cancer: a multi-institutional analysis

Abstract

Background The use of chemotherapy among patients with stage II colon cancer is controversial. We aimed to define the utilization and factors associated with the receipt of chemotherapy and the impact of chemotherapy on long-term prognosis among a large, multi-institutional cohort of patients. Materials and Methods We identified 876 patients who underwent resection for stage II colon cancer between 2004 and 2013 at one of 7 participating institutions. Overall (OS) and recurrence-free (RFS) survival time was calculated from the date of the index procedure to the date of death. Results 163 patients (18.6%) received adjuvant chemotherapy and this utilization decreased over time (P=0.003). Younger age (P<0.001), margin positivity (OR 12.16, 95%CI 2.57–57.52; P=0.002) and the presence of perineural invasion (OR 1.24, 95%CI 1.07–1.44; P=0.005) increased the likelihood of receiving chemotherapy. Receipt of chemotherapy was associated with improved median OS and RFS. After controlling for all factors, the addition of oxaliplatin to 5-flurorouracil did not affect survival, and there was no difference in OS (HR: 0.74, 95%CI 0.27–2.06; P=0.57) or RFS (HR 0.71, 95%CI 0.32–1.58; P=0.88) with adjuvant treatment, including for patients with high-risk features (OS - HR: 0.63, 95%CI 0.33–1.19; P=0.15; RFS - HR: 0.77, 95%CI 0.32–1.86; P=0.56). Conclusions The utilization of chemotherapy has declined over time after resection for stage II colon cancer. Chemotherapy was not independently associated with improved OS or RFS in this study group, including in patients with high-risk features. Future prospective studies should strive to identify the subset of stage II colon cancer patients that will benefit the most from the addition of adjuvant chemotherapy.

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

“…Many strategies have been applied to reduce the rate of incisional SSIs, including the administration of intravenous antibiotics, careful intraoperative bowel manipulation and the use of wound protectors. These strategies have proven effective, although there are still many incisional SSIs that are not preventable [84] and a subset of patients with less controllable risk factors (patients who are immunocompromised or are diabetic, patients undergoing emergency surgery, especially those with bowel perforation where the surgical field is highly contaminated) [88 , 89] . The most represented pathogens in incisional SSIs are actually bowel bacteria, such as E. coli , P. aeruginosa and Enterococcus spp.…”

Combined use of preoperative lymphocyte counts and the post/preoperative lymphocyte count ratio as a prognostic marker of recurrence after curative resection of stage II colon cancer

“…During the past two decades, advances in chemotherapy protocols have drastically decreased the risk of cancer recurrence and improved overall survival time of patients with stages III and IV [ 3 – 8 ]. On the other hand, use of chemotherapy among patients with stage II colon cancer is controversial [ 9 , 10 ], as is the usefulness of adjuvant chemotherapy after surgery. Therefore, better prognostic markers are needed to improve the outcomes of patients with CRC.…”

Predictive and Prognostic Effects of Primary Tumor Size on Colorectal Cancer Survival

“…Remarkably, correcting for tumor size showed no survival difference between stages II and III patients who received adjuvant chemotherapy. Stage II CRC patients without traditional high-risk features (pT4, bowel obstruction or perforation, positive resection margins/lymphovascular/perineural invasion, poorly differentiated histology or less than 12 lymph nodes resected) are generally observed on surveillance, although there is evidence that adjuvant chemotherapy may be beneficial ( 31 , 32 ). This study showed that tumors greater than 10cm are associated with worse outcomes.…”