Abstract
PurposeTo evaluate factors affecting the use and delay ≥8 weeks of adjuvant chemotherapy and the impact of chemotherapy use and delay on survival.MethodsBetween 2005 and 2012, consecutive patients with stage II and III colorectal cancer who were treated with major curative resection were enrolled.ResultsAmong 750 patients with stage II (n = 318) and III (n = 432) disease, 153 (20.4%) did not receive chemotherapy. Among 597 patients with adjuvant chemotherapy, 31 (5.2%) began chemotherapy 8 weeks or more after surgery. Factors associated with not receiving chemotherapy were: age ≥80 years (hazard ratio [HR] = 5.2), American Society of Anesthesiologists score ≥3 (HR = 1.9), underlying cerebrovascular disease (HR = 1.7), stage II disease (HR = 2.0), presence of postoperative complications (HR = 2.2), or intensive care unit admission (HR = 2.4). Factors associated with chemotherapy delay ≥8 weeks were: male sex (HR = 4.2), rectal primary cancer (HR = 5.4), or presence of postoperative complications (HR = 2.5). Independent prognostic factors for overall survival included TNM III stage (HR = 2.04) and chemotherapy delay ≥8 weeks (HR = 0.39) or <8 weeks (HR = 0.22). Independent prognostic factors for recurrence-free survival were TNM III stage (HR = 2.26) and chemotherapy delay <8 weeks (HR = 0.35).ConclusionsPostoperative complications were associated with both lack of and delayed chemotherapy. Timely initiation of chemotherapy, defined as <8 weeks, was a favorable prognostic factor for overall and recurrence-free survival. To increase the proportion of patients receiving chemotherapy and timely initiation of chemotherapy, surgical complications should be minimized after curative resection.
Highlights
Curative surgical resection is the primary treatment modality for colorectal cancer
Factors associated with chemotherapy delay 8 weeks were: male sex (HR = 4.2), rectal primary cancer (HR = 5.4), or presence of postoperative complications (HR = 2.5)
Postoperative complications were associated with both lack of and delayed chemotherapy
Summary
Curative surgical resection is the primary treatment modality for colorectal cancer. Adjuvant chemotherapy is performed to reduce the risk of metastasis and recurrence [1]. Quantifying the oncologic benefits of adjuvant chemotherapy is difficult, chemotherapy with fluorouracil and folinic acid improves survival by 3.6% in patients with stage II colorectal cancer [2]. According to a meta-analysis by Dube et al.[3], adjuvant chemotherapy with fluorouracil improved survival by 5% for patients with Dukes C colon cancer and adjuvant chemoradiation therapy increased survival by 9% for patients with Dukes B and C rectal cancer. In 2011, only 64% of patients with stage III colon cancer received adjuvant chemotherapy in the United States [4]. Use of chemotherapy is associated with age, race, underlying disease, marital and economic status, and occurrence of postoperative complications [5]
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