Association of Timing of Adjuvant Chemotherapy on Survival Outcomes in Colon Cancer Open Access
Narayan, Renuka (Spring 2018)
Published
Abstract
Background: Current guidelines regarding the treatment of colon cancer recommend initiation of adjuvant therapy within 120 days of definitive surgery when chemotherapy is needed. The objective of this study was to investigate the association of time to initiation of adjuvant chemotherapy with survival from colon cancer, while controlling for known strong predictors of survival.
Methods: The study cohort consists of stage I-III colon cancer patients from the Georgia Cancer Registry, who underwent definitive surgery followed by adjuvant chemotherapy. Time interval between diagnosis and adjuvant chemotherapy was divided into tertiles; time ≤ 46 days, 46 days < time ≤ 69 days and time> 69 days. Kaplan – Meier plots were obtained for all-cause and cancer specific survival in the three time tertiles. Multivariate analysis was done using Cox proportional hazard models controlling for potential confounders. Survival in the second and third tertiles were compared to the first to see if there was an association between the timing of adjuvant chemotherapy and outcomes.
Results: 93.4% of the 2106 colon cancer patients in the study cohort received adjuvant chemotherapy within 120 days of diagnosis. Age at diagnosis (p<0.01), race (p<0.01) and stage (p<0.01) were significantly associated with the timing of adjuvant therapy. There was no decrease in all–cause survival in the second vs first tertile (HR = 0.790, CI95%= 0.619, 1.009) or third vs first tertile ((HR = 0.966, CI95%= 0.76, 1.227). Cancer specific survival was significantly better in the second vs first tertile (HR = 0.738, CI95%= 0.56, 0.972).
Conclusion: In this study, delayed initiation of adjuvant chemotherapy was not significantly associated with decreased survival outcomes in stage I-III colon cancer patients.
Table of Contents
CHAPTER I 1
BACKGROUND 1
CHAPTER II (MANUSCRIPT) 8
INTRODUCTION 8
METHODS 10
RESULTS 16
DISCUSSION 19
REFERENCES 23
TABLES 30
FIGURES 33
CHAPTER III 36
SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS 36
APPENDICES 38
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