Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study.

Pamela Minicozzi, Massimo Vicentini, Kaire Innos, Clara Castro, Marcela Guevara, Fabrizio Stracci, MaCarmen Carmona-Garcia, Miguel Rodriguez-Barranco, Katrijn Vanschoenbeek, Elisabetta Rapiti, Alexander Katalinic, Rafael Marcos-Gragera, Liesbet Van Eycken, Maria José Sánchez, Magdalena Bielska-Lasota, Paolo Giorgi Rossi, Milena Sant

Research output: Contribution to journalArticlepeer-review

Abstract

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, 975 with 71 but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P textless 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.
Original languageEnglish
JournalEuropean Journal of Surgical Oncology
Issue number6
Publication statusPublished - Jun 1 2020

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