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

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

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