Neoadjuvant Chemotherapy Improves Survival in Patients with Clinical T4b Colon Cancer.

Publication Title

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

Authors

Ahmed N Dehal, John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USAFollow
Amanda N Graff-Baker, Center for Endocrine Tumors and Disorders, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Brooke Vuong, John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USAFollow
Trevan Fischer, John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
Samuel J Klempner
Shu-Ching ChangFollow
Gary Grunkemeier, Providence Health & Services, Medical Data Research Center, Portland, OR, USA.Follow
Anton J Bilchik, John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USAFollow
Melanie Goldfarb, John Wayne Cancer InstituteFollow

Document Type

Article

Publication Date

2-1-2018

Keywords

Adult; Aged; Chemotherapy, Adjuvant; Colonic Neoplasms; Databases, Factual; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Postoperative Period; Preoperative Period; Propensity Score; Survival Rate

Abstract

BACKGROUND: In 2016, the National Comprehensive Cancer Network included neoadjuvant chemotherapy as a treatment option for patients with clinical T4b colon cancer. However, there is little published data on the survival impact of neoadjuvant chemotherapy for locally advanced colon cancer.

METHODS: Adult patients with non-metastatic clinically staged T3 or T4 colon cancer who underwent surgical resection were identified from the National Cancer Data Base between 2006 and 2014. Treatment was categorized as neoadjuvant chemotherapy followed by surgery and surgery followed by adjuvant chemotherapy. Overall survival was compared between the two groups using propensity score matching.

RESULTS: Of 27,575 patients that met inclusion criteria, 26,654 (97%) were treated with surgery followed by adjuvant chemotherapy and 921 (3%) received neoadjuvant chemotherapy followed by surgery. After propensity score matching, patients with T4b colon cancer treated with neoadjuvant chemotherapy had a 23% lower risk of death at 3 years compared to patients that had adjuvant chemotherapy (HR 0.77, 95% CI 0.60-0.98; p = 0.04). However, neoadjuvant chemotherapy did not demonstrate a similar significant benefit for patients with T3 and T4a disease.

CONCLUSIONS: Patients with clinical T4b colon cancer treated with neoadjuvant chemotherapy may have an improved survival compared to those who receive adjuvant chemotherapy. Further prospective investigation is warranted.

Clinical Institute

Cancer

Clinical Institute

Digestive Health

Specialty/Research Institute

Gastroenterology

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery