Adjuvant Chemotherapy for Stage II Right-Sided and Left-Sided Colon Cancer: Analysis of SEER-Medicare Data

Abstract

Survival benefit from adjuvant chemotherapy is established for stage III colon cancer; however, uncertainty exists for stage II patients. Tumor heterogeneity, specifically microsatellite instability (MSI), which is more common in right-sided cancers, may be the reason for this observation. We examined the relationship between adjuvant chemotherapy and overall 5-year mortality for stage II colon cancer by location (right- vs left-side) as a surrogate for MSI. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified Medicare beneficiaries from 1992 to 2005 with AJCC stage II (n=23,578) and III (n=17,148) primary adenocarcinoma of the colon who underwent surgery for curative intent. Overall 5-year mortality was examined with Kaplan-Meier survival analysis and Cox proportional hazards regression with propensity score weighting. It was found that 18% of stage II patients (n=2941) with right-sided cancer and 22% (n=1693) with left-sided cancer received adjuvant chemotherapy. After adjustment, overall 5-year survival benefit from chemotherapy was observed only for stage III patients (right-sided: hazard ratio [HR], 0.64; 95% CI, 0.59-0.68; p<.001 and left-sided: HR, 0.61; 95% CI, 0.56-0.68; p<.001). No survival benefit was observed for stage II patients with either right-sided (HR, 0.97; 95% CI, 0.87-1.09; p=.64) or left-sided cancer (HR, 0.97; 95% CI, 0.84-1.12; p=.68). Among Medicare patients with stage II colon cancer, a substantial number receive adjuvant chemotherapy. Adjuvant chemotherapy did not improve overall 5-year survival for either right- or left-sided colon cancers. Our results reinforce existing guidelines and should be considered in treatment algorithms for older adults with stage II colon cancer.