Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; Oncode Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Eur J Surg Oncol. 2021 Aug;47(8):2060-2068. doi: 10.1016/j.ejso.2021.03.236. Epub 2021 Mar 16.
Although guidelines recommend adjuvant chemotherapy for stage III colon cancer patients, many patients do not receive adjuvant chemotherapy. The aim of this study was to identify reasons for guideline non-adherence and assess the effect on patient outcomes in a multicenter cohort of stage III colon cancer patients who received surgery plus adjuvant chemotherapy or surgery alone.
Patients who underwent surgery between 2007 and 2017 were included. Reasons for non-adherence were determined. Propensity score analyses with inverse probability weighting were performed to adjust for confounding factors. Cox proportional hazards regression and risk stratified analyses were performed to assess the association of guideline adherence and other potential predictors with recurrence free survival (RFS).
Data of 575 patients were included of whom 61% received adjuvant chemotherapy. In 87 of 222 patients (39%) who did not receive adjuvant chemotherapy, no reason was documented. Only age was predictive for receiving chemotherapy. Patients who received adjuvant chemotherapy had longer RFS (HR 0.42, 95%CI 0.29-0.62, p < 0.001). High T- and N-stage were associated with poorer RFS HR 2.0 (95%CI 1.58-2.71, p < 0.001) and HR 2.19 (95%CI 1.60-2.99, p < 0.001) respectively. Risk groups were identified with distinct prognosis and treatment effect and a nomogram is presented to visualize individualized RFS differences.
This study shows considerable variation in guideline adherence to adjuvant chemotherapy and poor documentation on reasons for non-adherence. Optimizing adherence and gaining insight in reasons for non-adherence is advocated as this can lead to significant RFS benefit, especially in patients with high T-and N-stage tumors.
尽管指南建议对 III 期结肠癌患者进行辅助化疗，但许多患者并未接受辅助化疗。本研究旨在确定不遵守指南的原因，并评估其对接受手术加辅助化疗或单独手术的 III 期结肠癌患者多中心队列中患者结局的影响。
纳入 2007 年至 2017 年间接受手术的患者。确定不遵守指南的原因。使用逆概率加权进行倾向评分分析以调整混杂因素。使用 Cox 比例风险回归和风险分层分析评估指南遵守情况和其他潜在预测因素与无复发生存（RFS）的相关性。
共纳入 575 例患者，其中 61%接受了辅助化疗。在未接受辅助化疗的 222 例患者中的 87 例（39%）中，未记录原因。只有年龄是接受化疗的预测因素。接受辅助化疗的患者 RFS 更长（HR 0.42，95%CI 0.29-0.62，p<0.001）。高 T 期和 N 期与较差的 RFS 相关（HR 2.0，95%CI 1.58-2.71，p<0.001）和 HR 2.19（95%CI 1.60-2.99，p<0.001）。分别确定了具有不同预后和治疗效果的风险组，并提出了一个列线图来可视化个体化 RFS 差异。
本研究表明，辅助化疗的指南遵守情况存在相当大的差异，并且对不遵守的原因记录不佳。提倡优化遵守情况并深入了解不遵守的原因，因为这可以带来显著的 RFS 获益，尤其是在 T 期和 N 期高肿瘤患者中。
