Enofe Nosayaba, Morris Andrew D, Liu Yuan, Liang Wendi, Wu Christina S, Sullivan Patrick S, Balch Glen G, Staley Charles A, Gillespie Theresa W, Shaffer Virginia O
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia.
J Surg Res. 2020 Aug;252:69-79. doi: 10.1016/j.jss.2020.02.016. Epub 2020 Mar 31.
There are variations in the use of adjuvant chemotherapy (AC) in stage II colon cancer (CRC). We sought to determine which patients received chemotherapy, what factors were associated with receipt of AC, and how this impacted overall survival.
Using the National Cancer Database, patients with stage II CRC who underwent surgical resection were selected; patients who received radiation or neoadjuvant chemotherapy were excluded. High-risk features (HRFs) were defined as pathological tumor stage IV, positive surgical margins, and perineural or lymphovascular invasion. Multivariable and subgroup analysis with eight subgroups stratified in the presence of HRFs, age, and the Charlson-Deyo score was performed.
Of 77,739 patients identified with stage II CRC, 18.3% received AC. Younger, healthier patients with HRFs had the highest chemotherapy receipt rate (46.7%), whereas patients without HRFs, ≥ 75 y, and with the Charlson-Deyo score of 2+ had the lowest rate (2.1%). Community cancer centers were more likely to initiate AC (odds ratio = 1.24 P < 0.01) especially among healthy HRF-negative patients and younger patients. No significant racial differences in AC use were observed. AC was associated with improved overall survival in subgroups with HRFs (hazard ratio [HR]: 0.81 P < 0.001; HR: 0.75 P < 0.001; HR: 0.65 P = 0.03; HR: 0.55, P < 0.001) but not in patients without HRFs.
AC receipt rates differed depending on patient age and type of institution delivering care. AC was associated with survival benefits only in patients with HRFs regardless of age. These findings are clinically relevant to inform appropriate use of AC in stage II CRC.
II期结肠癌（CRC）辅助化疗（AC）的使用存在差异。我们试图确定哪些患者接受了化疗，哪些因素与AC的接受相关，以及这如何影响总生存期。
使用国家癌症数据库，选择接受手术切除的II期CRC患者；排除接受放疗或新辅助化疗的患者。高风险特征（HRFs）定义为病理肿瘤分期IV期、手术切缘阳性以及神经周围或淋巴管浸润。对存在HRFs、年龄和Charlson-Deyo评分分层的八个亚组进行多变量和亚组分析。
在77739例确诊为II期CRC的患者中，18.3%接受了AC。年龄较小、健康状况较好且有HRFs的患者化疗接受率最高（46.7%），而无HRFs、年龄≥75岁且Charlson-Deyo评分为2分及以上的患者接受率最低（2.1%）。社区癌症中心更有可能启动AC（优势比=1.24，P<0.01），尤其是在健康的HRF阴性患者和年轻患者中。未观察到AC使用方面的显著种族差异。在有HRFs的亚组中，AC与总生存期改善相关（风险比[HR]：0.81，P<0.001；HR：0.75，P<0.001；HR：0.65，P=0.03；HR：0.55，P<0.001），但在无HRFs的患者中并非如此。
AC的接受率因患者年龄和提供护理的机构类型而异。无论年龄如何，AC仅与有HRFs的患者的生存获益相关。这些发现对于指导II期CRC中AC的合理使用具有临床意义。
