BACKGROUND: Several reports suggest that the efficacy of adjuvant chemotherapy on survival diminishes over time for colon cancer; however, precise timing of its loss of benefit has not been established. OBJECTIVE: This study aimed to determine the relationship between time to adjuvant chemotherapy and survival and to identify a threshold for increased risk of mortality. DESIGN: This was a retrospective study. Multivariable Cox proportional hazard modeling with restricted cubic splines was used to evaluate the adjusted association between time to adjuvant chemotherapy and overall survival and to establish an optimal threshold for the initiation of therapy. SETTINGS: Data were collected from the National Cancer Data Base. PATIENTS: Adults who received adjuvant chemotherapy following resection of stage II to III colon cancers were selected. MAIN OUTCOME MEASURES: The primary outcome measured was overall survival. RESULTS: A total of 7794 patients were included. After adjusting for clinical, tumor, and treatment characteristics, our model determined a critical threshold of chemotherapy initiation at 44 days from surgery, after which there was an increase in the overall mortality. At a median follow-up of 61 months, the risk of mortality was increased in those who received adjuvant chemotherapy after 44 days from surgery (adjusted HR, 1.14; 95% CI, 1.05-1.24; p = 0.002), but not in those who received chemotherapy before 44 days from surgery (p = 0.11). Each additional week of delay was associated with a 7% decrease in survival (HR, 1.07; 95% CI, 1.04-1.10; p < 0.001). LIMITATIONS: This study was limited by selection bias and the inability to compare specific chemotherapy regimens. CONCLUSIONS: This study objectively determines the optimal timing of adjuvant chemotherapy for patients with resected colon cancer. Delay beyond 6 weeks is associated with compromised survival. These findings emphasize the importance of the timely initiation of therapy, and suggest that efforts to enhance recovery following surgery have the potential to improve survival by decreasing delay to adjuvant chemotherapy.
BACKGROUND: Several reports suggest that the efficacy of adjuvant chemotherapy on survival diminishes over time for colon cancer; however, precise timing of its loss of benefit has not been established. OBJECTIVE: This study aimed to determine the relationship between time to adjuvant chemotherapy and survival and to identify a threshold for increased risk of mortality. DESIGN: This was a retrospective study. Multivariable Cox proportional hazard modeling with restricted cubic splines was used to evaluate the adjusted association between time to adjuvant chemotherapy and overall survival and to establish an optimal threshold for the initiation of therapy. SETTINGS: Data were collected from the National Cancer Data Base. PATIENTS: Adults who received adjuvant chemotherapy following resection of stage II to III colon cancers were selected. MAIN OUTCOME MEASURES: The primary outcome measured was overall survival. RESULTS: A total of 7794 patients were included. After adjusting for clinical, tumor, and treatment characteristics, our model determined a critical threshold of chemotherapy initiation at 44 days from surgery, after which there was an increase in the overall mortality. At a median follow-up of 61 months, the risk of mortality was increased in those who received adjuvant chemotherapy after 44 days from surgery (adjusted HR, 1.14; 95% CI, 1.05-1.24; p = 0.002), but not in those who received chemotherapy before 44 days from surgery (p = 0.11). Each additional week of delay was associated with a 7% decrease in survival (HR, 1.07; 95% CI, 1.04-1.10; p < 0.001). LIMITATIONS: This study was limited by selection bias and the inability to compare specific chemotherapy regimens. CONCLUSIONS: This study objectively determines the optimal timing of adjuvant chemotherapy for patients with resected colon cancer. Delay beyond 6 weeks is associated with compromised survival. These findings emphasize the importance of the timely initiation of therapy, and suggest that efforts to enhance recovery following surgery have the potential to improve survival by decreasing delay to adjuvant chemotherapy.
Authors: Oliver K Jawitz; Vignesh Raman; Yaron D Barac; Jatin Anand; Chetan B Patel; Robert J Mentz; Adam D DeVore; Carmelo Milano Journal: J Thorac Cardiovasc Surg Date: 2019-04-30 Impact factor: 5.209
Authors: Oliver K Jawitz; Vignesh Raman; Yaron Barac; Michael S Mulvihill; Carrie Moore; Ashley Y Choi; Matthew Hartwig; Jacob Klapper Journal: Ann Thorac Surg Date: 2019-07-02 Impact factor: 4.330
Authors: C A Farzaneh; A Pigazzi; W Q Duong; J C Carmichael; M J Stamos; F Dekhordi-Vakil; F Dayyani; J A Zell; M D Jafari Journal: Tech Coloproctol Date: 2022-08-30 Impact factor: 3.699
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
Authors: Michelle C Salazar; Joshua E Rosen; Zuoheng Wang; Brian N Arnold; Daniel C Thomas; Roy S Herbst; Anthony W Kim; Frank C Detterbeck; Justin D Blasberg; Daniel J Boffa Journal: JAMA Oncol Date: 2017-05-01 Impact factor: 31.777
Authors: Jeremy Watson; Michael K Ninh; Scott Ashford; Elyse M Cornett; Alan David Kaye; Ivan Urits; Omar Viswanath Journal: Oncol Ther Date: 2021-04-16
Authors: Jeanne Tie; Joshua D Cohen; Serigne N Lo; Yuxuan Wang; Lu Li; Michael Christie; Margaret Lee; Rachel Wong; Suzanne Kosmider; Iain Skinner; Hui Li Wong; Belinda Lee; Matthew E Burge; Desmond Yip; Christos S Karapetis; Timothy J Price; Niall C Tebbutt; Andrew M Haydon; Janine Ptak; Mary J Schaeffer; Natalie Silliman; Lisa Dobbyn; Maria Popoli; Cristian Tomasetti; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Peter Gibbs Journal: Int J Cancer Date: 2020-10-06 Impact factor: 7.396