Recurrence and cancer-specific death after adjuvant chemotherapy for Stage III colon cancer
| Autor: | Anil Keshava, Owen F. Dent, Charles Chan, E. L. Bokey, Pierre H. Chapuis, Matthew J. F. X. Rickard, Christopher J. Young, Peter Stewart |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Oncology medicine.medical_specialty Colorectal cancer medicine.medical_treatment Capecitabine 03 medical and health sciences 0302 clinical medicine FOLFOX Risk Factors Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Prospective Studies Aged Neoplasm Staging Chemotherapy business.industry Hazard ratio Gastroenterology Cancer Middle Aged medicine.disease digestive system diseases Oxaliplatin Chemotherapy Adjuvant Fluorouracil 030220 oncology & carcinogenesis Colonic Neoplasms Female 030211 gastroenterology & hepatology Neoplasm Recurrence Local business medicine.drug |
| Zdroj: | Colorectal Disease. 21:164-173 |
| ISSN: | 1462-8910 |
| Popis: | Aim The recommended standard of care for patients after resection of Stage III colon cancer is adjuvant 5-fluorouracil based chemotherapy - FOLFOX (fluorouracil, leucovorin with oxaliplatin) - or CAPOX (capecitabine, oxaliplatin). This may be modified in older patients or depending on comorbidity. This has been challenged recently as the apparent benefit of adjuvant chemotherapy may arise from improvements in surgery or preoperative imaging or pathology staging. This study compares recurrence and colon-cancer-specific death between patients who received postoperative adjuvant chemotherapy and those who did not. Method Prospectively recorded data from 363 consecutive patients who had a resection for Stage III colonic adenocarcinoma between 1995 and 2010 inclusive were analysed. Surviving patients were followed for at least 5 years. The suitability of patients for chemotherapy was discussed routinely at multidisciplinary team meetings. The incidence of recurrence and colon-cancer-specific death was evaluated by competing risk methods. Results After adjustment for the competing risk of non-colorectal cancer death, there was no significant difference in recurrence between the 204 patients who received chemotherapy and the 159 who did not [hazard ratio (HR) 0.94, 95% CI 0.66-1.32, P = 0.700) and no significant difference in colon-cancer-specific death (HR 0.73, 95% CI 0.50-1.04, P = 0.084; HR 0.88, 95% CI 0.57-1.36, P = 0.577 after adjustment for relevant covariates). Conclusion These findings question the routine use of chemotherapy after complete mesocolic excision for Stage III colon cancer. Recurrence and cancer-specific death, assessed by competing risk methods, should be the standard outcomes for evaluating the effectiveness of adjuvant chemotherapy after potentially curative resection. |
| Databáze: | OpenAIRE |
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