Adjuvant Chemotherapy Is Associated with Improved Survival for Stage III Colon Cancer When Initiated Beyond 8 Weeks

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2023 Jun 20

PMID 37340108

Authors

Fasih Ali Ahmed

Victoria S Wu

Hanna Kakish

Luke Rothermel

Sharon L Stein

Emily Steinhagen

Richard Hoehn

Affiliations

Soon will be listed here.

Abstract

Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend adjuvant chemotherapy (AC) within 6-8 weeks of surgical resection for patients with stage III colon cancer. However, postoperative complications or prolonged surgical recovery may affect the receipt of AC. The aim of this study was to assess the utility of AC for patients with prolonged postoperative recovery.

Methods: We queried the National Cancer Database (2010-2018) for patients with resected stage III colon cancer. Patients were categorized as having either normal or prolonged length of stay (PLOS: >7 days, 75th percentile). Multivariable Cox proportional hazard regression and logistic regressions were used to identify factors associated with overall survival and receipt of AC.

Results: Of the 113,387 patients included, 30,196 (26.6%) experienced PLOS. Of the 88,115 (77.7%) patients who received AC, 22,707 (25.8%) initiated AC more than 8 weeks after surgery. Patients with PLOS were less likely to receive AC (71.5% vs. 80.0%, OR: 0.72, 95%CI=0.70-0.75) and displayed inferior survival (75 vs. 116 months, HR: 1.39, 95%CI=1.36-1.43). Receipt of AC was also associated with patient factors such as high socioeconomic status, private insurance, and White race (p<0.05 for all). AC within and after 8 weeks of surgery was associated with improved survival for patients with both normal LOS and PLOS (normal LOS: <8 weeks HR: 0.56, 95% CI: 0.54-0.59, >8 weeks HR: 0.68, 95% CI: 0.65-0.71; PLOS: <8 weeks HR: 0.51, 95% CI: 0.48-0.54, >8 weeks HR: 0.63, 95% CI 0.60-0.67). AC was associated with significantly improved survival if initiated up to 15 weeks postoperatively (normal LOS: HR: 0.72, 95%CI=0.61-0.85; PLOS: HR: 0.75, 95%CI=0.62-0.90), and very few patients (<3.0%) initiated AC beyond this time.

Conclusion: Receipt of AC for stage III colon cancer may be affected by surgical complications or otherwise prolonged recovery. Timely and even delayed AC (>8 weeks) are both associated with improved overall survival. These findings highlight the importance of delivering guideline-based systemic therapies, even after complicated surgical recovery.

References

Siegel R, Miller K, Fuchs H, Jemal A . Cancer statistics, 2022. CA Cancer J Clin. 2022; 72(1):7-33. DOI: 10.3322/caac.21708. View

Tashiro J, Yamaguchi S, Ishii T, Suzuki A, Kondo H, Morita Y . Inferior oncological prognosis of surgery without oral chemotherapy for stage III colon cancer in clinical settings. World J Surg Oncol. 2014; 12:145. PMC: 4029940. DOI: 10.1186/1477-7819-12-145. View

Yothers G, OConnell M, Allegra C, Kuebler J, Colangelo L, Petrelli N . Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin Oncol. 2011; 29(28):3768-74. PMC: 3188282. DOI: 10.1200/JCO.2011.36.4539. View

Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T . Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004; 350(23):2343-51. DOI: 10.1056/NEJMoa032709. View

Veldkamp R, Kuhry E, Hop W, Jeekel J, Kazemier G, Bonjer H . Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005; 6(7):477-84. DOI: 10.1016/S1470-2045(05)70221-7. View

Lacy A, Garcia-Valdecasas J, Delgado S, Castells A, Taura P, Pique J . Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002; 359(9325):2224-9. DOI: 10.1016/S0140-6736(02)09290-5. View

Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F . Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg. 2014; 260(1):23-30. DOI: 10.1097/SLA.0000000000000499. View

van der Geest L, Portielje J, Wouters M, Weijl N, Tanis B, Tollenaar R . Complicated postoperative recovery increases omission, delay and discontinuation of adjuvant chemotherapy in patients with Stage III colon cancer. Colorectal Dis. 2013; 15(10):e582-91. DOI: 10.1111/codi.12288. View

Merkow R, Bentrem D, Mulcahy M, Chung J, Abbott D, Kmiecik T . Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Ann Surg. 2013; 258(6):847-53. DOI: 10.1097/SLA.0000000000000312. View

10.

Swords D, Mulvihill S, Brooke B, Skarda D, Firpo M, Scaife C . Disparities in utilization of treatment for clinical stage I-II pancreatic adenocarcinoma by area socioeconomic status and race/ethnicity. Surgery. 2018; 165(4):751-759. DOI: 10.1016/j.surg.2018.10.035. View

11.

Turner M, Farrow N, Rhodin K, Sun Z, Adam M, Mantyh C . Delay in Adjuvant Chemotherapy and Survival Advantage in Stage III Colon Cancer. J Am Coll Surg. 2018; 226(4):670-678. DOI: 10.1016/j.jamcollsurg.2017.12.048. View

12.

Krell R, Girotti M, Dimick J . Extended length of stay after surgery: complications, inefficient practice, or sick patients?. JAMA Surg. 2014; 149(8):815-20. PMC: 4245077. DOI: 10.1001/jamasurg.2014.629. View

13.

Lima I, Yasui Y, Scarfe A, Winget M . Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada. Cancer. 2011; 117(16):3833-40. DOI: 10.1002/cncr.25954. View

14.

Mazmudar A, Castle J, Yang A, Bentrem D . The association of length of hospital stay with readmission after elective pancreatic resection. J Surg Oncol. 2018; 118(1):7-14. DOI: 10.1002/jso.25093. View

15.

Schneider E, Canner J, Gani F, Kim Y, Ejaz A, Spolverato G . Early versus late hospital readmission after pancreaticoduodenectomy. J Surg Res. 2015; 196(1):74-81. DOI: 10.1016/j.jss.2015.02.043. View

16.

Sadot E, Brennan M, Lee S, Allen P, Gonen M, Groeger J . Readmission after pancreatic resection: causes and causality pattern. Ann Surg Oncol. 2014; 21(13):4342-50. PMC: 4529329. DOI: 10.1245/s10434-014-3841-0. View

17.

Hyder O, Dodson R, Nathan H, Schneider E, Weiss M, Cameron J . Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States. JAMA Surg. 2013; 148(12):1095-102. PMC: 3983984. DOI: 10.1001/jamasurg.2013.2509. View

18.

Kastenberg Z, Morton J, Visser B, Norton J, Poultsides G . Hospital readmission after a pancreaticoduodenectomy: an emerging quality metric?. HPB (Oxford). 2013; 15(2):142-8. PMC: 3719921. DOI: 10.1111/j.1477-2574.2012.00563.x. View

19.

Ahmad S, Edwards M, Sutton J, Grewal S, Hanseman D, Maithel S . Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg. 2012; 256(3):529-37. DOI: 10.1097/SLA.0b013e318265ef0b. View

20.

Kent T, Sachs T, Callery M, Vollmer Jr C . Readmission after major pancreatic resection: a necessary evil?. J Am Coll Surg. 2011; 213(4):515-23. DOI: 10.1016/j.jamcollsurg.2011.07.009. View