Department of Biomedical Sciences, University of Houston College of Medicine, Houston, TX.
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
Surgery. 2022 Sep;172(3):859-868. doi: 10.1016/j.surg.2022.04.042. Epub 2022 Jul 19.
Guidelines recommend adjuvant chemotherapy for stage II colon cancer with high-risk features, but there has been little study on compliance with guidelines. This work sought to evaluate compliance with adjuvant chemotherapy and factors associated with compliance in high-risk stage II colon cancer. This work's hypothesis was that compliance with adjuvant chemotherapy recommendations is low, but improves overall survival when used.
The National Cancer Database was reviewed for stage II high-risk colon cancers that underwent curative resection from 2010 to 2017. The cases were stratified into adjuvant chemotherapy and no adjuvant chemotherapy cohorts. A multivariate logistic regression identified factors associated with adjuvant chemotherapy compliance. Propensity-score matching was performed to balance the cohorts and Kaplan-Meier analysis assessed overall survival. The main outcome measures were adjuvant chemotherapy compliance, factors associated with compliance, and overall survival in high-risk stage II colon cancer.
A total of 52,609 patients were evaluated, and 23.2% received adjuvant chemotherapy. The factors associated with noncompliance included older age (odds ratio 0.919; 95% confidence interval 0.915-0.922; P < .001), Medicaid (odds ratio 0.720; 95% confidence interval 0.623-0.832; P < .001) payor, greater comorbidities (odds ratio 0.423; 95% confidence interval 0.334-0.530; P < .001), and residing in the Midwest (odds ratio 0.898; 95% confidence interval 0.812-0.994; P = .037). All of the known high-risk features were significantly independently associated with compliance. In a matched cohort, adjuvant chemotherapy significantly improved the 5-year overall survival (78.1% vs 66.6%; P < .001).
Nationally, there is low compliance with adjuvant chemotherapy in high-risk stage II colon cancer. Despite the low compliance, adjuvant chemotherapy was associated with improved overall survival. Demographic variables were associated with poor compliance, whereas tumor factors were associated with increased compliance. These results highlighted the disparities in care and opportunities to improve outcomes in high-risk stage II colon cancer.
指南建议对具有高危特征的 II 期结肠癌进行辅助化疗，但对指南的依从性研究甚少。本研究旨在评估高危 II 期结肠癌患者对辅助化疗的依从性，并探讨与依从性相关的因素。本研究的假设是，辅助化疗建议的依从性较低，但使用时可提高总体生存率。
本研究回顾性分析了 2010 年至 2017 年间接受根治性切除术的 II 期高危结肠癌患者的国家癌症数据库。将病例分为接受辅助化疗和未接受辅助化疗两组。采用多因素逻辑回归分析确定与辅助化疗依从性相关的因素。采用倾向评分匹配法平衡两组，采用 Kaplan-Meier 分析评估总生存率。主要观察指标为高危 II 期结肠癌患者的辅助化疗依从性、与依从性相关的因素及总体生存率。
共评估了 52609 例患者，其中 23.2%接受了辅助化疗。与不依从相关的因素包括年龄较大（比值比 0.919；95%置信区间 0.915-0.922；P <.001）、医疗补助（Medicaid）（比值比 0.720；95%置信区间 0.623-0.832；P <.001）支付方式、合并症较多（比值比 0.423；95%置信区间 0.334-0.530；P <.001）以及居住在中西部地区（比值比 0.898；95%置信区间 0.812-0.994；P =.037）。所有已知的高危特征均与依从性显著相关。在匹配队列中，辅助化疗显著提高了 5 年总生存率（78.1% vs 66.6%；P <.001）。
在全国范围内，高危 II 期结肠癌患者对辅助化疗的依从性较低。尽管依从性较低，但辅助化疗与总体生存率的提高相关。人口统计学变量与较差的依从性相关，而肿瘤因素与较高的依从性相关。这些结果突显了高危 II 期结肠癌患者治疗中的差异，并为改善该类患者的治疗结果提供了机会。
