Department of Biomedical Sciences, University of Houston College of Medicine, Houston, Texas, USA.
Houston Colon PLLC, Houston, Texas, USA.
Colorectal Dis. 2022 Jan;24(1):40-49. doi: 10.1111/codi.15937. Epub 2021 Oct 18.
Stage II colon cancers are a heterogeneous category, with controversy over use of adjuvant chemotherapy (AC). Patients with high-risk features may benefit from AC to improve overall survival (OS). Current guidelines do not routinely recommend AC in low-risk cases, but the actual use and benefit on OS in this cohort have not been fully examined on a national scale. We aimed to evaluate the use and impact of AC on OS in low-risk Stage II colon cancer.
The national cancer database was reviewed for Stage II colon cancers undergoing curative resection (2010-2015). Cases with preoperative radio-chemotherapy or high-risk features were excluded. Cases were stratified into 'AC' and 'no AC' cohorts, and then propensity score matched. Kaplan-Meier and Cox regression analysed OS. The main outcome measures were the incidence and impact of AC on OS in low-risk Stage II colon cancer.
Of 39 926 patients evaluated, 8.2% (n = 3275) received AC. Matching resulted in 3275 cases per cohort. AC significantly improved 1-, 3- and 5-year OS versus no AC (P = 0.0017). The 5-year absolute risk reduction was 2.6%, relative risk reduction 12%, with a number needed to treat of 38. In the Cox model, AC remained significantly associated with increased OS (hazard ratio 0.816; 95% CI 0.713-0.934; P < 0.003).
From this dataset, AC was associated with improved OS in low-risk Stage II disease. These findings from a large-scale sample question current guidelines and the need for better risk stratification. Further study with more robust variables is warranted to determine AC best practices.
II 期结肠癌是一个异质性类别，关于辅助化疗（AC）的应用存在争议。具有高危特征的患者可能受益于 AC 以提高总生存期（OS）。目前的指南通常不建议在低危病例中使用 AC，但在全国范围内尚未充分检查该队列中 AC 在 OS 上的实际应用和获益。我们旨在评估低危 II 期结肠癌中 AC 的应用和对 OS 的影响。
回顾性分析了 2010 年至 2015 年接受根治性切除术的 II 期结肠癌患者的国家癌症数据库。排除术前放化疗或具有高危特征的病例。将病例分为“AC”和“无 AC”队列，然后进行倾向评分匹配。采用 Kaplan-Meier 和 Cox 回归分析 OS。主要观察指标为低危 II 期结肠癌中 AC 的发生率和对 OS 的影响。
在评估的 39926 例患者中，8.2%（n=3275）接受了 AC。匹配后每个队列有 3275 例。与无 AC 相比，AC 显著改善了 1、3 和 5 年 OS（P=0.0017）。5 年绝对风险降低 2.6%，相对风险降低 12%，治疗需 38 例。在 Cox 模型中，AC 与 OS 增加显著相关（风险比 0.816；95%CI 0.713-0.934；P<0.003）。
从这个数据集来看，AC 与低危 II 期疾病的 OS 改善相关。这些来自大规模样本的发现对当前的指南提出了质疑，也需要更好的风险分层。需要进一步进行更稳健变量的研究，以确定 AC 的最佳实践。
