TY - JOUR
T1 - Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study
AU - Minicozzi, Pamela
AU - Vicentini, Massimo
AU - Innos, Kaire
AU - Castro, Clara
AU - Guevara, Marcela
AU - Stracci, Fabrizio
AU - Carmona-Garcia, MaCarmen
AU - Rodriguez-Barranco, Miguel
AU - Vanschoenbeek, Katrijn
AU - Rapiti, Elisabetta
AU - Katalinic, Alexander
AU - Marcos-Gragera, Rafael
AU - Van Eycken, Liesbet
AU - Sánchez, Maria José
AU - Bielska-Lasota, Magdalena
AU - Rossi, Paolo Giorgi
AU - Sant, Milena
AU - European HR Working Group on colorectal cancer
N1 - Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
PY - 2020/6
Y1 - 2020/6
N2 - INTRODUCTION: For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established.MATERIALS AND METHODS: We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use.RESULTS: Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time.CONCLUSIONS: Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
AB - INTRODUCTION: For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established.MATERIALS AND METHODS: We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use.RESULTS: Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time.CONCLUSIONS: Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Antineoplastic Agents/therapeutic use
KW - Colonic Neoplasms/diagnosis
KW - Combined Modality Therapy/methods
KW - Comorbidity
KW - Europe/epidemiology
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasm Staging
KW - Population Surveillance
KW - Prognosis
KW - Retrospective Studies
KW - Survival Rate/trends
KW - Time-to-Treatment
KW - Young Adult
U2 - 10.1016/j.ejso.2020.02.023
DO - 10.1016/j.ejso.2020.02.023
M3 - Article
C2 - 32147427
VL - 46
SP - 1151
EP - 1159
JO - Eur. J. Surg. Oncol.
JF - Eur. J. Surg. Oncol.
SN - 0748-7983
IS - 6
ER -