Administration of adjuvant chemotherapy for stage II-III colon cancer patients: An European population-based study

Abstract

The advantage of adjuvant chemotherapy (ACT) for treating Stage III colon cancer patients is well established and widely accepted. However, many patients with Stage III colon cancer do not receive ACT. Moreover, there are controversies around the effectiveness of ACT for Stage II patients. We investigated the administration of ACT and its association with overall survival in resected Stage II (overall and stratified by low-/high-risk) and Stage III colon cancer patients in three European countries including The Netherlands (2009-2014), Belgium (2009-2013) and Sweden (2009-2014). Hazard ratios (HR) for death were obtained by Cox regression models adjusted for potential confounders. A total of 60244 resected colon cancer patients with pathological Stages II and III were analyzed. A small proportion (range 9-24%) of Stage II and over half (range 55-68%) of Stage III patients received ACT. Administration of ACT in Stages II and III tumors decreased with higher age of patients. Administration of ACT was significantly associated with higher overall survival in high-risk Stage II patients (in The Netherlands (HR; 95%CI = 0.82 (0.67-0.99), Belgium (0.73; 0.59-0.90) and Sweden (0.58; 0.44-0.75)), and in Stage III patients (in The Netherlands (0.47; 0.43-0.50), Belgium (0.46; 0.41-0.50) and Sweden (0.48; 0.43-0.54)). In Stage III, results were consistent across subgroups including elderly patients. Our results show an association of ACT with higher survival among Stage III and high-risk Stage II colon cancer patients. Further investigations are needed on the selection criteria of Stages II and III colon cancer patients for ACT.

Keywords: adjuvant chemotherapy; colon cancer; survival; variations.

Figure 1

Age-standardized trend of administration of adjuvant chemotherapy in low-/high-risk Stage II and Stage III patients resected between 2009 and 2014.

Figure 2

Adjusted survival curves stratified by total Stage II (a), low-risk Stage II (b), high-risk Stage II (c) and Stage III (d), for patients receiving postsurgical adjuvant chemotherapy (ACT) and surgery only. Classification of low- and high-risk Stage II was done according to available high-risk prognostic factors for each country shown in Table 1. The survival estimates were obtained from Cox regression models with adjustment for gender, age group, tumor location, tumor size, type of surgery and lymph node count (the two latter factors were not available in Belgium).