Stage II colon cancer: adjuvant chemotherapy may do more harm than good

  • Fu J & al.
  • Therap Adv Gastroenterol
  • 22 Aug 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • An analysis of the Surveillance, Epidemiology, and End Results (SEER) database shows no survival benefit, and some potential harm, with adjuvant chemotherapy (ACT) for stage II colon cancer.

Why this matters

  • The authors argue that the ACT real-world benefit is much lower than previously believed, and that colon-cancer-specific death (CCSD) should replace OS as a primary endpoint in clinical trials.

Study design

  • Propensity-score matching and retrospective analyses of the SEER database (n=58,133).
  • Funding: Various Chinese government sources.

Key results

  • 25.66% of patients received ACT.
  • Overall CCSD rate was 19.95%, and non-CCSD rate was 25.78%.
  • ACT was associated with more CCSD (HR, 1.23; P<.001 and less non-ccsd p>
  • Findings were confirmed in propensity-score matched analysis of 13,806 pairs (HR, 1.16 and HR, 0.60, both P<.001>
  • A competing-risk survival regression model was used to construct a nomogram with good accuracy for predicting CCSD (C-index, 0.661).
  • ACT was tied to increased CCSD in patients at high (HR, 1.24; P<.001 and medium risk p but not low>

    Limitations

    • Retrospective analysis.
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