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Factors Associated with Receipt of Adjuvant Chemotherapy in Stage II Colon Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The benefits of chemotherapy in stage II colon cancer remain unclear, but it is recommended for high-risk stage II disease. Which patients receive chemotherapy and its impact on survival remains undetermined.

Methods

The National Cancer Database was surveyed between 2004 and 2016 for stage II colon cancer patients. Patients were categorized as high- or average-risk as defined by the National Comprehensive Cancer Network. The demographic characteristics of high- and average-risk patients who did and did not receive chemotherapy were compared using univariate and multivariable analyses. The survival of high- and average-risk patients was compared based on receipt of chemotherapy with Cox hazard ratios and Kaplan–Meier curves.

Results

Overall, 84,424 patients met the inclusion criteria. A total of 34,868 patients were high-risk and 49,556 were average-risk. In high-risk patients, the risk factors for not receiving chemotherapy included increasing age, distance from the treatment facility, Charlson–Deyo score, and lack of insurance. In average-risk patients, factors associated with receipt of chemotherapy were decreasing age, distance from the treatment facility, Charlson–Deyo score, and non-academic association of the treatment facility. In both, chemotherapy was significantly associated with increased survival on the Kaplan–Meier curve. In the Cox hazard ratio, only high-risk patients benefited from chemotherapy (hazard ratio 1.183, confidence interval 1.116–1.254).

Conclusions

Factors associated with not receiving chemotherapy in high-risk stage II colon cancers included increasing age, medical comorbidities, increasing distance from the treatment facility, and lack of insurance. Chemotherapy is associated with improved overall survival in high-risk patients.

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Funding

This study was funded by departmental funding.

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Authors and Affiliations

  1. Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Meridith C. Ginesi MD, Jonathan T. Bliggenstorfer MD, Daphine M. Kwesiga MD, Samantha H. Xu BS, MPH, Diana Jodeh MD, J. Eva Selfridge MD, Sharon L. Stein MD, FACS, FASCRS & Emily F. Steinhagen MD, FACS, FASCRS

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  1. Meridith C. Ginesi MD
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  2. Jonathan T. Bliggenstorfer MD
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  3. Daphine M. Kwesiga MD
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  4. Samantha H. Xu BS, MPH
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  5. Diana Jodeh MD
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  6. J. Eva Selfridge MD
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  7. Sharon L. Stein MD, FACS, FASCRS
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  8. Emily F. Steinhagen MD, FACS, FASCRS
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Correspondence to Emily F. Steinhagen MD, FACS, FASCRS.

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Disclosure

Meridith C. Ginesi, Jonathan T. Bliggenstorfer, Daphine M. Kwesiga, Samantha H. Xu, Diana Jodeh, J. Eva Selfridge, Sharon L. Stein, and Emily F. Steinhagen have no conflicts of interest to disclose.

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This work was presented as a podium presentation at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting in Tampa, FL, USA, 30 April–4 May 2022.

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Ginesi, M.C., Bliggenstorfer, J.T., Kwesiga, D.M. et al. Factors Associated with Receipt of Adjuvant Chemotherapy in Stage II Colon Cancer. Ann Surg Oncol 30, 5511–5518 (2023). https://doi.org/10.1245/s10434-023-13631-z

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  • DOI: https://doi.org/10.1245/s10434-023-13631-z

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