Timing of adjuvant chemotherapy in colorectal cancer
Aim Delay in commencing adjuvant therapy for colorectal cancer seems to impair survival in some retrospective studies. This study was planned to evaluate its impact on survival. Methods This was a retrospective study enrolling patients registered from 2000 to 2012 in two large cancer‐dedicated insti...
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| Veröffentlicht in: | Colorectal disease 2016-09, Vol.18 (9), p.871-876 |
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| creator | dos Santos, L. V. Faria, T. M. V. Lima, A. B. C. Abdalla, K. C. de Moraes, E. D. Cruz, M. R. Lima, J. P. |
| description | Aim
Delay in commencing adjuvant therapy for colorectal cancer seems to impair survival in some retrospective studies. This study was planned to evaluate its impact on survival.
Methods
This was a retrospective study enrolling patients registered from 2000 to 2012 in two large cancer‐dedicated institutions in Brazil. The primary outcome was overall survival according to early vs late chemotherapy initiation. The interval between the primary surgery and the start of adjuvant chemotherapy was calculated. Survival was estimated using the Kaplan–Meier method and the impact of multiple prognostic factors on survival by Cox regression analysis.
Results
By the end of 2012, a total of 1963 Stage II and III colorectal patients were identified and 1318 patients received adjuvant chemotherapy, with 22% and 46% of those starting adjuvant chemotherapy within 6 weeks and 8 weeks of surgery. The median period of follow‐up was 41 months. Patients starting chemotherapy within 6–8 weeks of surgery had longer overall survival compared with those who started after (6 weeks vs later, hazard ratio 0.76, 95% CI 0.57–0.99, P = 0.046; 8 weeks vs later, hazard ratio 0.74, 95% CI 0.59–0.93, P = 0.011). In the multivariate analysis, age, stage, histological grade, angiolymphatic invasion, emergency surgery and preoperative therapy were independent prognostic factors, but the interval between surgery and start of adjuvant therapy was not.
Conclusion
In this large retrospective study, the standard prognostic factors impacted on survival whereas the timing of adjuvant therapy did not. Patients with delayed adjuvant chemotherapy may have worse prognostic factors which could play a major role in their poor outcome. |
| doi_str_mv | 10.1111/codi.13306 |
| format | Article |
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Delay in commencing adjuvant therapy for colorectal cancer seems to impair survival in some retrospective studies. This study was planned to evaluate its impact on survival.
Methods
This was a retrospective study enrolling patients registered from 2000 to 2012 in two large cancer‐dedicated institutions in Brazil. The primary outcome was overall survival according to early vs late chemotherapy initiation. The interval between the primary surgery and the start of adjuvant chemotherapy was calculated. Survival was estimated using the Kaplan–Meier method and the impact of multiple prognostic factors on survival by Cox regression analysis.
Results
By the end of 2012, a total of 1963 Stage II and III colorectal patients were identified and 1318 patients received adjuvant chemotherapy, with 22% and 46% of those starting adjuvant chemotherapy within 6 weeks and 8 weeks of surgery. The median period of follow‐up was 41 months. Patients starting chemotherapy within 6–8 weeks of surgery had longer overall survival compared with those who started after (6 weeks vs later, hazard ratio 0.76, 95% CI 0.57–0.99, P = 0.046; 8 weeks vs later, hazard ratio 0.74, 95% CI 0.59–0.93, P = 0.011). In the multivariate analysis, age, stage, histological grade, angiolymphatic invasion, emergency surgery and preoperative therapy were independent prognostic factors, but the interval between surgery and start of adjuvant therapy was not.
Conclusion
In this large retrospective study, the standard prognostic factors impacted on survival whereas the timing of adjuvant therapy did not. Patients with delayed adjuvant chemotherapy may have worse prognostic factors which could play a major role in their poor outcome.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/codi.13306</identifier><identifier>PMID: 26900665</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>adjuvant ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents - therapeutic use ; Brazil ; Chemotherapy ; Chemotherapy, Adjuvant - methods ; colorectal cancer ; Colorectal Neoplasms - drug therapy ; Colorectal Neoplasms - pathology ; Digestive System Surgical Procedures ; Female ; Fluorouracil - therapeutic use ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Invasiveness ; Neoplasm Staging ; Organoplatinum Compounds - therapeutic use ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Time Factors ; Young Adult</subject><ispartof>Colorectal disease, 2016-09, Vol.18 (9), p.871-876</ispartof><rights>Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland</rights><rights>Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4006-6c704316e19283eb432610016dfabb2996873de13f9144546d3697d6880d3b0d3</citedby><cites>FETCH-LOGICAL-c4006-6c704316e19283eb432610016dfabb2996873de13f9144546d3697d6880d3b0d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcodi.13306$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcodi.13306$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26900665$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>dos Santos, L. V.</creatorcontrib><creatorcontrib>Faria, T. M. V.</creatorcontrib><creatorcontrib>Lima, A. B. C.</creatorcontrib><creatorcontrib>Abdalla, K. C.</creatorcontrib><creatorcontrib>de Moraes, E. D.</creatorcontrib><creatorcontrib>Cruz, M. R.</creatorcontrib><creatorcontrib>Lima, J. P.</creatorcontrib><title>Timing of adjuvant chemotherapy in colorectal cancer</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>Aim
Delay in commencing adjuvant therapy for colorectal cancer seems to impair survival in some retrospective studies. This study was planned to evaluate its impact on survival.
Methods
This was a retrospective study enrolling patients registered from 2000 to 2012 in two large cancer‐dedicated institutions in Brazil. The primary outcome was overall survival according to early vs late chemotherapy initiation. The interval between the primary surgery and the start of adjuvant chemotherapy was calculated. Survival was estimated using the Kaplan–Meier method and the impact of multiple prognostic factors on survival by Cox regression analysis.
Results
By the end of 2012, a total of 1963 Stage II and III colorectal patients were identified and 1318 patients received adjuvant chemotherapy, with 22% and 46% of those starting adjuvant chemotherapy within 6 weeks and 8 weeks of surgery. The median period of follow‐up was 41 months. Patients starting chemotherapy within 6–8 weeks of surgery had longer overall survival compared with those who started after (6 weeks vs later, hazard ratio 0.76, 95% CI 0.57–0.99, P = 0.046; 8 weeks vs later, hazard ratio 0.74, 95% CI 0.59–0.93, P = 0.011). In the multivariate analysis, age, stage, histological grade, angiolymphatic invasion, emergency surgery and preoperative therapy were independent prognostic factors, but the interval between surgery and start of adjuvant therapy was not.
Conclusion
In this large retrospective study, the standard prognostic factors impacted on survival whereas the timing of adjuvant therapy did not. Patients with delayed adjuvant chemotherapy may have worse prognostic factors which could play a major role in their poor outcome.</description><subject>adjuvant</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Brazil</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant - methods</subject><subject>colorectal cancer</subject><subject>Colorectal Neoplasms - drug therapy</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Digestive System Surgical Procedures</subject><subject>Female</subject><subject>Fluorouracil - therapeutic use</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Staging</subject><subject>Organoplatinum Compounds - therapeutic use</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Young Adult</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1Lw0AQhhdRrFYv_gDJUYTUnWw62Rylai0WS7HW47LZbGxqPupuovbfm34exYFh5vDMw_AScgG0A03dqDJOO8AYxQNyAj4yFxjww_XuuTwE2iKn1s4pBQyAH5OWhyGliN0T4k_SPC3enTJxZDyvv2RROWqm87KaaSMXSyctHFVmpdGqkpmjZKG0OSNHicysPt_ONnl9uJ_0Ht3hqD_o3Q5d5Td6F1VAfQaoIfQ405HPPITVE3Eio8gLQ-QBizWwJATf7_oYMwyDGDmnMYuabpOrjXdhys9a20rkqVU6y2Shy9oK4F7Aw8bZ_QcKiIxxGjTo9QZVprTW6EQsTJpLsxRAxSpQsQpUrANt4Mutt45yHe_RXYINABvgO8308g-V6I3uBjupu7lJbaV_9jfSfAgMWNAVb8998fI09qY4ngpkv12NjIA</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>dos Santos, L. V.</creator><creator>Faria, T. M. V.</creator><creator>Lima, A. B. C.</creator><creator>Abdalla, K. C.</creator><creator>de Moraes, E. D.</creator><creator>Cruz, M. R.</creator><creator>Lima, J. P.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><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>7X8</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>201609</creationdate><title>Timing of adjuvant chemotherapy in colorectal cancer</title><author>dos Santos, L. V. ; Faria, T. M. V. ; Lima, A. B. C. ; Abdalla, K. C. ; de Moraes, E. D. ; Cruz, M. R. ; Lima, J. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4006-6c704316e19283eb432610016dfabb2996873de13f9144546d3697d6880d3b0d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>adjuvant</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Brazil</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant - methods</topic><topic>colorectal cancer</topic><topic>Colorectal Neoplasms - drug therapy</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Digestive System Surgical Procedures</topic><topic>Female</topic><topic>Fluorouracil - therapeutic use</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Staging</topic><topic>Organoplatinum Compounds - therapeutic use</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>dos Santos, L. V.</creatorcontrib><creatorcontrib>Faria, T. M. V.</creatorcontrib><creatorcontrib>Lima, A. B. C.</creatorcontrib><creatorcontrib>Abdalla, K. C.</creatorcontrib><creatorcontrib>de Moraes, E. D.</creatorcontrib><creatorcontrib>Cruz, M. R.</creatorcontrib><creatorcontrib>Lima, J. P.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>dos Santos, L. V.</au><au>Faria, T. M. V.</au><au>Lima, A. B. C.</au><au>Abdalla, K. C.</au><au>de Moraes, E. D.</au><au>Cruz, M. R.</au><au>Lima, J. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Timing of adjuvant chemotherapy in colorectal cancer</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2016-09</date><risdate>2016</risdate><volume>18</volume><issue>9</issue><spage>871</spage><epage>876</epage><pages>871-876</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>Aim
Delay in commencing adjuvant therapy for colorectal cancer seems to impair survival in some retrospective studies. This study was planned to evaluate its impact on survival.
Methods
This was a retrospective study enrolling patients registered from 2000 to 2012 in two large cancer‐dedicated institutions in Brazil. The primary outcome was overall survival according to early vs late chemotherapy initiation. The interval between the primary surgery and the start of adjuvant chemotherapy was calculated. Survival was estimated using the Kaplan–Meier method and the impact of multiple prognostic factors on survival by Cox regression analysis.
Results
By the end of 2012, a total of 1963 Stage II and III colorectal patients were identified and 1318 patients received adjuvant chemotherapy, with 22% and 46% of those starting adjuvant chemotherapy within 6 weeks and 8 weeks of surgery. The median period of follow‐up was 41 months. Patients starting chemotherapy within 6–8 weeks of surgery had longer overall survival compared with those who started after (6 weeks vs later, hazard ratio 0.76, 95% CI 0.57–0.99, P = 0.046; 8 weeks vs later, hazard ratio 0.74, 95% CI 0.59–0.93, P = 0.011). In the multivariate analysis, age, stage, histological grade, angiolymphatic invasion, emergency surgery and preoperative therapy were independent prognostic factors, but the interval between surgery and start of adjuvant therapy was not.
Conclusion
In this large retrospective study, the standard prognostic factors impacted on survival whereas the timing of adjuvant therapy did not. Patients with delayed adjuvant chemotherapy may have worse prognostic factors which could play a major role in their poor outcome.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>26900665</pmid><doi>10.1111/codi.13306</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | adjuvant Adult Age Factors Aged Aged, 80 and over Antineoplastic Agents - therapeutic use Brazil Chemotherapy Chemotherapy, Adjuvant - methods colorectal cancer Colorectal Neoplasms - drug therapy Colorectal Neoplasms - pathology Digestive System Surgical Procedures Female Fluorouracil - therapeutic use Humans Kaplan-Meier Estimate Male Middle Aged Neoadjuvant Therapy Neoplasm Invasiveness Neoplasm Staging Organoplatinum Compounds - therapeutic use Prognosis Proportional Hazards Models Retrospective Studies Survival Rate Time Factors Young Adult |
| title | Timing of adjuvant chemotherapy in colorectal cancer |
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