Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study
Introduction Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patient...
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| Veröffentlicht in: | World journal of surgery 2016-02, Vol.40 (2), p.447-455 |
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| creator | Bergquist, J. R. Thiels, C. A. Shubert, C. R. Habermann, E. B. Hayman, A. V. Zielinski, M. D. Mathis, K. L. |
| description | Introduction
Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.
Materials and methods
The National Cancer Data Base (NCDB 2006–2011) was queried for patients over 80 with Stages II and III rectal cancer. The primary outcome was overall survival. Patients were stratified based upon therapy group. Univariate group comparisons were made. Unadjusted Kaplan–Meier and multivariable Cox proportional hazards modeling survival analyses were performed.
Results
The query yielded 3098 patients over 80 with Stage II (
N
= 1566) or Stage III (
N
= 1532) disease. Approximately, half of the patients received surgery only. Kaplan–Meier analysis showed improved survival for patients receiving neoadjuvant and/or adjuvant therapy in addition to surgery, but there was no significant difference between those that received guideline concordant care (GCC), neoadjuvant chemoradiation only, or post-operative chemotherapy only. Cox proportional hazard modeling identified age >90 and margin positivity as independent risk factors for decreased overall survival.
Conclusion
Analysis of NCDB data for Stages II and III rectal cancer in patients over 80 shows a survival benefit of adjuvant and/or neoadjuvant therapy over surgery alone. There does not appear to be a difference in survival between patients who received neoadjuvant chemoradiation, post-resection adjuvant chemotherapy, or GCC. |
| doi_str_mv | 10.1007/s00268-015-3319-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1760896328</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1760896328</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4926-be4a7270165a3068f3f66b3fec1f7618833d59cd29e9a57071f87a06a696c0aa3</originalsourceid><addsrcrecordid>eNqFkd1u1DAQhS0EokvhAbhBlrgpFwH_bMbJFdpNWyhaFalbxKU160xoqmyytRNQXocnxekuP0JCXNkef-fM2Iex51K8lkKYN0EIBVkiZJpoLfPEPGAzOdcqUVrph2wmNMzjXuoj9iSEWyGkAQGP2ZGCFMCYfMa-XwRe3NC262_I427knedXWNbY113Lrw_FuuWLsqzva33H14P_Qn7kS2qpql2NDa-ibtU5bJoxol-xdVTyK3J9vCumk59MYhN-1pTkm_EtX_DL-y6_iVPskS8xED-5LE6Xr_i6H8rxKXtUYRPo2WE9Zp_Oz66L98nq47uLYrFK3DxXkGxojkYZISFFLSCrdAWw0RU5WRmQWaZ1meauVDnlmBphZJUZFICQgxOI-pid7H13vrsbKPR2WwdHTYMtdUOw0-dlOWiVRfTlX-htN_j4kolKU5MKqWSk5J5yvgvBU2V3vt6iH60UdgrQ7gO0MUA7BWhN1Lw4OA-bLZW_FD8Ti0C-B77VDY3_d7SfP6yX58KAgahVe22IsjZG-MfY_5zoB04etUY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1755750121</pqid></control><display><type>article</type><title>Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study</title><source>Wiley-Blackwell Journals</source><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Bergquist, J. R. ; Thiels, C. A. ; Shubert, C. R. ; Habermann, E. B. ; Hayman, A. V. ; Zielinski, M. D. ; Mathis, K. L.</creator><creatorcontrib>Bergquist, J. R. ; Thiels, C. A. ; Shubert, C. R. ; Habermann, E. B. ; Hayman, A. V. ; Zielinski, M. D. ; Mathis, K. L.</creatorcontrib><description>Introduction
Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.
Materials and methods
The National Cancer Data Base (NCDB 2006–2011) was queried for patients over 80 with Stages II and III rectal cancer. The primary outcome was overall survival. Patients were stratified based upon therapy group. Univariate group comparisons were made. Unadjusted Kaplan–Meier and multivariable Cox proportional hazards modeling survival analyses were performed.
Results
The query yielded 3098 patients over 80 with Stage II (
N
= 1566) or Stage III (
N
= 1532) disease. Approximately, half of the patients received surgery only. Kaplan–Meier analysis showed improved survival for patients receiving neoadjuvant and/or adjuvant therapy in addition to surgery, but there was no significant difference between those that received guideline concordant care (GCC), neoadjuvant chemoradiation only, or post-operative chemotherapy only. Cox proportional hazard modeling identified age >90 and margin positivity as independent risk factors for decreased overall survival.
Conclusion
Analysis of NCDB data for Stages II and III rectal cancer in patients over 80 shows a survival benefit of adjuvant and/or neoadjuvant therapy over surgery alone. There does not appear to be a difference in survival between patients who received neoadjuvant chemoradiation, post-resection adjuvant chemotherapy, or GCC.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-015-3319-7</identifier><identifier>PMID: 26566779</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Additional Therapy ; Adjuvant Therapy ; Aged, 80 and over ; Cardiac Surgery ; Chemoradiotherapy, Adjuvant - mortality ; Chemotherapy, Adjuvant - mortality ; Databases, Factual ; Female ; General Surgery ; Humans ; Kaplan-Meier Estimate ; Male ; Medicine ; Medicine & Public Health ; National Cancer Data Base ; National Comprehensive Cancer Network Guideline ; Neoadjuvant Therapy - mortality ; Neoplasm Staging ; Original Scientific Report ; Proportional Hazards Models ; Rectal Cancer ; Rectal Neoplasms - mortality ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Rectal Neoplasms - therapy ; Surgery ; Survival Rate ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>World journal of surgery, 2016-02, Vol.40 (2), p.447-455</ispartof><rights>Société Internationale de Chirurgie 2015</rights><rights>2016 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>Société Internationale de Chirurgie 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4926-be4a7270165a3068f3f66b3fec1f7618833d59cd29e9a57071f87a06a696c0aa3</citedby><cites>FETCH-LOGICAL-c4926-be4a7270165a3068f3f66b3fec1f7618833d59cd29e9a57071f87a06a696c0aa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-015-3319-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-015-3319-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,1418,27926,27927,41490,42559,45576,45577,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26566779$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bergquist, J. R.</creatorcontrib><creatorcontrib>Thiels, C. A.</creatorcontrib><creatorcontrib>Shubert, C. R.</creatorcontrib><creatorcontrib>Habermann, E. B.</creatorcontrib><creatorcontrib>Hayman, A. V.</creatorcontrib><creatorcontrib>Zielinski, M. D.</creatorcontrib><creatorcontrib>Mathis, K. L.</creatorcontrib><title>Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Introduction
Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.
Materials and methods
The National Cancer Data Base (NCDB 2006–2011) was queried for patients over 80 with Stages II and III rectal cancer. The primary outcome was overall survival. Patients were stratified based upon therapy group. Univariate group comparisons were made. Unadjusted Kaplan–Meier and multivariable Cox proportional hazards modeling survival analyses were performed.
Results
The query yielded 3098 patients over 80 with Stage II (
N
= 1566) or Stage III (
N
= 1532) disease. Approximately, half of the patients received surgery only. Kaplan–Meier analysis showed improved survival for patients receiving neoadjuvant and/or adjuvant therapy in addition to surgery, but there was no significant difference between those that received guideline concordant care (GCC), neoadjuvant chemoradiation only, or post-operative chemotherapy only. Cox proportional hazard modeling identified age >90 and margin positivity as independent risk factors for decreased overall survival.
Conclusion
Analysis of NCDB data for Stages II and III rectal cancer in patients over 80 shows a survival benefit of adjuvant and/or neoadjuvant therapy over surgery alone. There does not appear to be a difference in survival between patients who received neoadjuvant chemoradiation, post-resection adjuvant chemotherapy, or GCC.</description><subject>Abdominal Surgery</subject><subject>Additional Therapy</subject><subject>Adjuvant Therapy</subject><subject>Aged, 80 and over</subject><subject>Cardiac Surgery</subject><subject>Chemoradiotherapy, Adjuvant - mortality</subject><subject>Chemotherapy, Adjuvant - mortality</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>National Cancer Data Base</subject><subject>National Comprehensive Cancer Network Guideline</subject><subject>Neoadjuvant Therapy - mortality</subject><subject>Neoplasm Staging</subject><subject>Original Scientific Report</subject><subject>Proportional Hazards Models</subject><subject>Rectal Cancer</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectal Neoplasms - therapy</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkd1u1DAQhS0EokvhAbhBlrgpFwH_bMbJFdpNWyhaFalbxKU160xoqmyytRNQXocnxekuP0JCXNkef-fM2Iex51K8lkKYN0EIBVkiZJpoLfPEPGAzOdcqUVrph2wmNMzjXuoj9iSEWyGkAQGP2ZGCFMCYfMa-XwRe3NC262_I427knedXWNbY113Lrw_FuuWLsqzva33H14P_Qn7kS2qpql2NDa-ibtU5bJoxol-xdVTyK3J9vCumk59MYhN-1pTkm_EtX_DL-y6_iVPskS8xED-5LE6Xr_i6H8rxKXtUYRPo2WE9Zp_Oz66L98nq47uLYrFK3DxXkGxojkYZISFFLSCrdAWw0RU5WRmQWaZ1meauVDnlmBphZJUZFICQgxOI-pid7H13vrsbKPR2WwdHTYMtdUOw0-dlOWiVRfTlX-htN_j4kolKU5MKqWSk5J5yvgvBU2V3vt6iH60UdgrQ7gO0MUA7BWhN1Lw4OA-bLZW_FD8Ti0C-B77VDY3_d7SfP6yX58KAgahVe22IsjZG-MfY_5zoB04etUY</recordid><startdate>201602</startdate><enddate>201602</enddate><creator>Bergquist, J. R.</creator><creator>Thiels, C. A.</creator><creator>Shubert, C. R.</creator><creator>Habermann, E. B.</creator><creator>Hayman, A. V.</creator><creator>Zielinski, M. D.</creator><creator>Mathis, K. L.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>201602</creationdate><title>Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study</title><author>Bergquist, J. R. ; Thiels, C. A. ; Shubert, C. R. ; Habermann, E. B. ; Hayman, A. V. ; Zielinski, M. D. ; Mathis, K. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4926-be4a7270165a3068f3f66b3fec1f7618833d59cd29e9a57071f87a06a696c0aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Additional Therapy</topic><topic>Adjuvant Therapy</topic><topic>Aged, 80 and over</topic><topic>Cardiac Surgery</topic><topic>Chemoradiotherapy, Adjuvant - mortality</topic><topic>Chemotherapy, Adjuvant - mortality</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>National Cancer Data Base</topic><topic>National Comprehensive Cancer Network Guideline</topic><topic>Neoadjuvant Therapy - mortality</topic><topic>Neoplasm Staging</topic><topic>Original Scientific Report</topic><topic>Proportional Hazards Models</topic><topic>Rectal Cancer</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectal Neoplasms - therapy</topic><topic>Surgery</topic><topic>Survival Rate</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bergquist, J. R.</creatorcontrib><creatorcontrib>Thiels, C. A.</creatorcontrib><creatorcontrib>Shubert, C. R.</creatorcontrib><creatorcontrib>Habermann, E. B.</creatorcontrib><creatorcontrib>Hayman, A. V.</creatorcontrib><creatorcontrib>Zielinski, M. D.</creatorcontrib><creatorcontrib>Mathis, K. L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bergquist, J. R.</au><au>Thiels, C. A.</au><au>Shubert, C. R.</au><au>Habermann, E. B.</au><au>Hayman, A. V.</au><au>Zielinski, M. D.</au><au>Mathis, K. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2016-02</date><risdate>2016</risdate><volume>40</volume><issue>2</issue><spage>447</spage><epage>455</epage><pages>447-455</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Introduction
Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.
Materials and methods
The National Cancer Data Base (NCDB 2006–2011) was queried for patients over 80 with Stages II and III rectal cancer. The primary outcome was overall survival. Patients were stratified based upon therapy group. Univariate group comparisons were made. Unadjusted Kaplan–Meier and multivariable Cox proportional hazards modeling survival analyses were performed.
Results
The query yielded 3098 patients over 80 with Stage II (
N
= 1566) or Stage III (
N
= 1532) disease. Approximately, half of the patients received surgery only. Kaplan–Meier analysis showed improved survival for patients receiving neoadjuvant and/or adjuvant therapy in addition to surgery, but there was no significant difference between those that received guideline concordant care (GCC), neoadjuvant chemoradiation only, or post-operative chemotherapy only. Cox proportional hazard modeling identified age >90 and margin positivity as independent risk factors for decreased overall survival.
Conclusion
Analysis of NCDB data for Stages II and III rectal cancer in patients over 80 shows a survival benefit of adjuvant and/or neoadjuvant therapy over surgery alone. There does not appear to be a difference in survival between patients who received neoadjuvant chemoradiation, post-resection adjuvant chemotherapy, or GCC.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>26566779</pmid><doi>10.1007/s00268-015-3319-7</doi><tpages>9</tpages></addata></record> |
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| ispartof | World journal of surgery, 2016-02, Vol.40 (2), p.447-455 |
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| source | Wiley-Blackwell Journals; MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Additional Therapy Adjuvant Therapy Aged, 80 and over Cardiac Surgery Chemoradiotherapy, Adjuvant - mortality Chemotherapy, Adjuvant - mortality Databases, Factual Female General Surgery Humans Kaplan-Meier Estimate Male Medicine Medicine & Public Health National Cancer Data Base National Comprehensive Cancer Network Guideline Neoadjuvant Therapy - mortality Neoplasm Staging Original Scientific Report Proportional Hazards Models Rectal Cancer Rectal Neoplasms - mortality Rectal Neoplasms - pathology Rectal Neoplasms - surgery Rectal Neoplasms - therapy Surgery Survival Rate Thoracic Surgery Vascular Surgery |
| title | Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study |
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