NEW YORK (Reuters Health) - In select patients with American Joint Committee on Cancer (AJCC) stage II colon cancer, adjuvant chemotherapy after resection improves survival, according to a retrospective review of more than 3,700 patients treated in California.Dr. Joseph Kim from City of Hope Comprehensive Cancer Center in Duarte, California told Reuters Health that his data "do not support routine use of chemotherapy for all patients with stage II disease."
Rather, he said "clinicians must use their best judgment in identifying appropriate patients and weighing the risks and benefits. Our data do not provide specific characteristics that physicians should use, but do demonstrate that physicians are currently making those decisions."
Currently, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend against the routine use of chemotherapy for patients with stage II colon cancer.
Prognosis with AJCC stage II colon cancer is good, with 5-year survival rates ranging from 72% to 85%, Dr. Kim and colleagues note in their paper, published online June 20th in Cancer. Still, recurrent disease develops in about a quarter of stage II patients, and most of those will die as a result.
Because the role of adjuvant chemotherapy in patients with stage II disease is controversial, the researchers assessed its effect in a large, heterogeneous population of patients with AJCC stage II colon cancer.
Using the California Cancer Surveillance Program, they identified 3,716 patients who had curative resection for pathologically-confirmed AJCC stage II colon cancer (i.e., T3 or T4 and N0) between 1991 and 2006. A total of 916 patients had surgery plus adjuvant chemotherapy, whereas 2,800 had surgery alone.
Patients who received adjuvant chemotherapy were disproportionately younger and had larger tumors (>5 cm), and their tumors were located more often in the descending or sigmoid colon. There was no difference in sex or tumor differentiation between the two groups. It is noteworthy, the researchers say, that patients who received adjuvant chemotherapy were more apt to have at least 12 lymph nodes examined.
In comparing the surgery plus chemotherapy vs surgery alone groups, the researchers found that the adjuvant chemo was associated with a significant improvement in overall survival time (median survival 12 vs 9.2 years; P < 0.001).
In multivariate analysis, adjuvant chemotherapy emerged as an independent predictor of improved survival (hazard ratio, 0.88; P = 0.03).
Age was also tied to survival; compared to age under 50, hazard ratios were 1.86 for age 51 to 64 and 3.67 for age 65 or older. Women were 12% less likely than men to surpass the median survival. And patients with at least 12 nodes examined were 24% less likely to surpass the medial survival compared to patients with fewer nodes taken.
The researchers believe the observed survival difference between the two groups could have been even more pronounced if contemporary systemic chemotherapy agents had been used.
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