Abstract
BackgroundIt remains controversial whether patients with Stage II colon cancer would benefit from chemotherapy after radical surgery. This study aims to assess the real effectiveness of chemotherapy in patients with stage II colon cancer undergoing radical surgery and to construct survival prediction models to predict the survival benefits of chemotherapy.MethodsData for stage II colon cancer patients with radical surgery were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (1:1) was performed according to receive or not receive chemotherapy. Competitive risk regression models were used to assess colon cancer cause-specific death (CSD) and non-colon cancer cause-specific death (NCSD). Survival prediction nomograms were constructed to predict overall survival (OS) and colon cancer cause-specific survival (CSS). The predictive abilities of the constructed models were evaluated by the concordance indexes (C-indexes) and calibration curves.ResultsA total of 25,110 patients were identified, 21.7% received chemotherapy, and 78.3% were without chemotherapy. A total of 10,916 patients were extracted after propensity score matching. The estimated 3-year overall survival rates of chemotherapy were 0.7% higher than non- chemotherapy. The estimated 5-year and 10-year overall survival rates of non-chemotherapy were 1.3 and 2.1% higher than chemotherapy, respectively. Survival prediction models showed good discrimination (the C-indexes between 0.582 and 0.757) and excellent calibration.ConclusionsChemotherapy improves the short-term (43 months) survival benefit of stage II colon cancer patients who received radical surgery. Survival prediction models can be used to predict OS and CSS of patients receiving chemotherapy as well as OS and CSS of patients not receiving chemotherapy and to make individualized treatment recommendations for stage II colon cancer patients who received radical surgery.
Highlights
It remains controversial whether patients with Stage II colon cancer would benefit from chemotherapy after radical surgery
Two recent studies [7, 8] based on more than 100,000 patients, both concluded that all patients with stage II colon cancer, whether high or low risk, experienced significant improvements in overall survival (OS) associated with receiving chemotherapy, while some clinical studies showed that chemotherapy failed to improved survival [9, 10]
Clinical characteristics of patients and survival outcomes A total of 25,110 patients with stage II colon cancer were included from the SEER database
Summary
It remains controversial whether patients with Stage II colon cancer would benefit from chemotherapy after radical surgery. Chemotherapy is widely accepted as the standard treatment for stage III colon cancer to prevent recurrence and metastasis, controversy remains over whether stage II colon cancer should receive it after radical surgery. Both The American Society of Clinical Oncology (ASCO) clinical guidelines [5] and The European Society for Medical Oncology (ESMO) guidelines [6] recommend patients with high-risk factors to receive postoperative adjuvant chemotherapy. Two recent studies [7, 8] based on more than 100,000 patients, both concluded that all patients with stage II colon cancer, whether high or low risk, experienced significant improvements in overall survival (OS) associated with receiving chemotherapy, while some clinical studies showed that chemotherapy failed to improved survival [9, 10]
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