A C R K Bos1, F N van Erning2, Y R B M van Gestel3, G J M Creemers4, C J A Punt5, M G H van Oijen6, V E P P Lemmens2. 1. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. Electronic address: a.bos@iknl.nl. 2. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. 3. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. 4. Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands. 5. Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 6. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
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 13-16 weeks post-surgery. Multivariable regressions were performed to assess the influence of several factors on the probability of starting treatment within 8 weeks 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 8 weeks. Factors associated with starting treatment after 8 weeks were older age (Odds ratio (OR) 65-74 versus < 65 years 1.3 (95% confidence interval (CI): 1.14-1.58); OR ⩾ 75 versus < 65 years 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 5-8 weeks post-surgery showed no decrease in OS compared to initiation within 4 weeks (Hazard ratio (HR) 5-6 weeks 0.9 (0.79-1.11); HR 7-8 weeks 1.1 (0.91-1.30)). However, commencing beyond 8 weeks was associated with decreased OS compared to initiation within 8 weeks (HR 9-10 weeks 1.4 (1.21-1.68); HR 11-12 weeks 1.3 (1.06-1.59); HR 13-16 weeks 1.7 (1.23-2.23)). CONCLUSION: Our data support initiating adjuvant chemotherapy in stage III colon cancer patients within 8 weeks post-surgery.
BACKGROUND: Currently available data suggest that delaying the start of adjuvant chemotherapy in colon cancerpatients 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 cancerpatients 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 13-16 weeks post-surgery. Multivariable regressions were performed to assess the influence of several factors on the probability of starting treatment within 8 weeks 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 8 weeks. Factors associated with starting treatment after 8 weeks were older age (Odds ratio (OR) 65-74 versus < 65 years 1.3 (95% confidence interval (CI): 1.14-1.58); OR ⩾ 75 versus < 65 years 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 5-8 weeks post-surgery showed no decrease in OS compared to initiation within 4 weeks (Hazard ratio (HR) 5-6 weeks 0.9 (0.79-1.11); HR 7-8 weeks 1.1 (0.91-1.30)). However, commencing beyond 8 weeks was associated with decreased OS compared to initiation within 8 weeks (HR 9-10 weeks 1.4 (1.21-1.68); HR 11-12 weeks 1.3 (1.06-1.59); HR 13-16 weeks 1.7 (1.23-2.23)). CONCLUSION: Our data support initiating adjuvant chemotherapy in stage III colon cancerpatients within 8 weeks post-surgery.
Authors: Larissa A Meyer; Javier Lasala; Maria D Iniesta; Alpa M Nick; Mark F Munsell; Qiuling Shi; Xin Shelley Wang; Katherine E Cain; Karen H Lu; Pedro T Ramirez Journal: Obstet Gynecol Date: 2018-08 Impact factor: 7.661
Authors: Lawrence Lee; Nathalie Wong-Chong; Justin J Kelly; George J Nassif; Matthew R Albert; John R T Monson Journal: Surg Endosc Date: 2018-07-02 Impact factor: 4.584