Adjuvant chemotherapy is associated with improved overall survival in select patients with Stage II colon cancer: A National Cancer Database analysis

Abstract

Background and Objectives: Guidelines for Stage II colon cancer recommend adjuvant chemotherapy (AC) only for tumors with high-risk features, but long-term outcomes data are mixed. We aimed to determine if AC was associated with a survival benefit in this population.Methods: Patients were identified from the National Cancer Database and included if they met the following criteria: diagnosis of Stage II colon cancer, surgery, survival data, and complete data on six high-risk features. The cohort of 57 335 patients was stratified by receipt of AC. Subgroup analysis was performed on patients under the age of 65 years with no comorbidities. Overall survival (OS) was the primary endpoint.Results: An increasing number of high-risk features was associated with significantly decreased median OS. AC was associated with significantly increased OS for patients with 0, 1, 2, and ≥3 high-risk features. On subgroup analysis, receipt of AC was associated with a reduced risk of death (hazard ratio: 0.66; confidence interval: 0.59-0.74). For patients in the subgroup who had a T4 tumor, AC was associated with increased OS (92.7 vs. 83.6 months).Conclusions: AC should be considered for all younger, healthy patients with Stage II colon cancer and may be associated with a survival benefit for patients with T4 disease. K E Y W O R D S adjuvant chemotherapy, colon cancer, high risk, NCDB, Stage II 1 | INTRODUCTION Colorectal cancer remains the third most common malignancy and the second most common cause of cancer-related death worldwide. 1 Decades of research have led to advancements in understanding colorectal cancer pathophysiology, resulting in better treatment options and screening strategies. As a result, in the United States, annual mortality for colorectal cancer has steadily declined.Globally, however, colorectal cancer continues to be a leading cause of cancer death. 2 In 2020, colorectal cancer reached 10% worldwide incidence and accounted for 9.4% of total cancer-related mortality. 3 Ninety percent of colorectal cancer is diagnosed in patients 50 years and older. However, more recent data indicate a rising incidence and mortality rate for patients under the age of 50 years. 4,5

A computed tomography-based multitask deep learning model for predicting tumour stroma ratio and treatment outcomes in patients with colorectal cancer: a multicentre cohort study

“…Adjuvant chemotherapy is considered a standard treatment for patients with stage III CRC, while controversial for stage II patients. Currently, the optimal selection criteria for suitable candidates for chemotherapy remains uncertain, and only a small subset of patients could benefit from adjuvant chemotherapy 31 . Given the demonstrated ability of the MDL model to risk-stratify patients in our study, there is a potential for the MDL signature to enhance adjuvant treatment decision-making.…”

Combined preoperative prognostic nutritional index and D-dimer score predicts outcome in colorectal cancer

“…However, studies that directly and concurrently analyze the levels of inflammatory cytokines and PNI and DD remain lacking. Clinically, adjuvant chemotherapy was conventionally recommended for high-risk stage II and stage III CRC patients [68,69], which could greatly improve the DFS and OS [68][69][70][71]. Previously, pT4, lymph-vascular or perineural invasion, perforation or obstruction presentation, poorly differentiated histology, or lymph node harvest less than 12 were well acknowledged as risk factors in CRC [72].…”

Comment on “Risk factors for metachronous peritonealcarcinomatosis after radical resection for patients with nonmetastatic pT3‐4 colon cancer”

“…Furthermore, serum tumor biomarkers, tumor stage and growth pattern, number of LNs examined, venous and perineural invasions, tumor deposit count, and adjuvant chemotherapy were reported to be associated with the prognosis of patients with colorectal cancer. [2][3][4][5][6][7][8][9] Hence, the prognostic significance of mPC on patients with pT3-4 nonmetastatic colon cancer could not be merely determined using Kaplan-Meier survival analysis. To overcome these confounding factors, we suggest the authors perform univariate and multivariate Cox regression analysis to see if mPC has an independent survival impact on such patients.…”