Andreas Teufel1, Michael Gerken2, Alois Fürst3, Matthias Ebert4, Ina Hohenthanner5, Monika Klinkhammer-Schalke6. 1. Department of Medicine II, Division of Hepatology, Division of Clinical Bioinformatics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Preventive Medicine and Digital Health Baden-Württemberg (CPD(BW)), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: andreas.teufel@medma.uni-heidelberg.de. 2. Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany. 3. Colorectal Cancer Center, Caritas Hospital St. Josef, Regensburg, Germany. 4. Department of Medicine II, Division of Hepatology, Division of Clinical Bioinformatics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Preventive Medicine and Digital Health Baden-Württemberg (CPD(BW)), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 5. Stuttgart Medical Center, Department of Child and Adolescent Psychiatry, Stuttgart, Germany. 6. Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany; Association of German Tumor Centers ADT, Berlin, Germany.
Abstract
BACKGROUND: The benefit of adjuvant chemotherapy in Union for International Cancer Control (UICC) stage III colon cancer has been demonstrated in numerous studies. While adjuvant chemotherapy is generally not recommended in stage II patients, its role in high-risk UICC stage II disease (e.g. T4 tumours) remains controversial. METHODS: The present population-based multicenter cohort study investigated the influence of adjuvant chemotherapy on survival and recurrence rates in high-risk UICC stage II T4N0M0 tumours. Based on an anonymised nationwide ADT data set from 31 clinical cancer registries, we identified a total of 6651 patients with a T4 tumour of the colon, of whom 6131 were eligible for survival analysis. A matched-pair analysis based on propensity scores (PSM) was performed with a subset of 3986 patients. RESULTS: Multivariable analyses demonstrated a significant benefit of adjuvant chemotherapy for overall survival (OS) (hazard ratio [HR]: 0.711, 95% confidence interval [CI]: 0.643-0.785, p < 0.001), cumulative recurrence rate (HR: 0.780, 95% CI: 0.681-0.893, p < 0.001), and recurrence-free survival (HR: 0.715, 95% CI: 0.652-0.785, p < 0.001) further confirmed by the matched-pair cohort. CONCLUSION: This large and representative study demonstrated a significant advantage of adjuvant chemotherapy for patients with T4 UICC stage II colon cancer in terms of OS, recurrence rate, and relapse-free survival. Based on these results, adjuvant chemotherapy should be recommended for these patients.
BACKGROUND: The benefit of adjuvant chemotherapy in Union for International Cancer Control (UICC) stage III colon cancer has been demonstrated in numerous studies. While adjuvant chemotherapy is generally not recommended in stage II patients, its role in high-risk UICC stage II disease (e.g. T4 tumours) remains controversial. METHODS: The present population-based multicenter cohort study investigated the influence of adjuvant chemotherapy on survival and recurrence rates in high-risk UICC stage II T4N0M0 tumours. Based on an anonymised nationwide ADT data set from 31 clinical cancer registries, we identified a total of 6651 patients with a T4 tumour of the colon, of whom 6131 were eligible for survival analysis. A matched-pair analysis based on propensity scores (PSM) was performed with a subset of 3986 patients. RESULTS: Multivariable analyses demonstrated a significant benefit of adjuvant chemotherapy for overall survival (OS) (hazard ratio [HR]: 0.711, 95% confidence interval [CI]: 0.643-0.785, p < 0.001), cumulative recurrence rate (HR: 0.780, 95% CI: 0.681-0.893, p < 0.001), and recurrence-free survival (HR: 0.715, 95% CI: 0.652-0.785, p < 0.001) further confirmed by the matched-pair cohort. CONCLUSION: This large and representative study demonstrated a significant advantage of adjuvant chemotherapy for patients with T4 UICC stage II colon cancer in terms of OS, recurrence rate, and relapse-free survival. Based on these results, adjuvant chemotherapy should be recommended for these patients.
Authors: Karlijn L van Rooijen; Jeroen W G Derksen; Helena M Verkooijen; Geraldine R Vink; Miriam Koopman Journal: Int J Cancer Date: 2022-06-21 Impact factor: 7.316