The Slow Adoption of Neoadjuvant Treatment for Clinical T4b Colon Cancer: A National Cancer Database Analysis

IF 1.9 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2025-09-19 DOI:10.1002/jso.70093

Beiqun Zhao, Adam Truong

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引用次数: 0

Abstract

BACKGROUND

Emerging data support the use of neoadjuvant treatment (NAT), particularly immunotherapy in microsatellite instability–high (MSI-H) tumors. We evaluate national trends in NAT utilization for clinical T4b colon cancers and its association with overall survival, with a focus on MSI-H tumors.

METHODS

We conducted a retrospective cohort study using the National Cancer Database (2010–2022) evaluating patients with non-metastatic clinical T4b colonic adenocarcinoma who underwent colectomy. The primary outcome measures were trends in NAT utilization and overall survival.

RESULTS

Among 8862 patients with clinical T4b colon cancer, NAT utilization increased over time, peaking at 28% in the most recent quartile. NAT recipients were more likely younger, healthier, and to be treated at academic centers. NAT was associated with higher R0 resection rates (83% vs 77%, p < 0.001) and significantly longer mean overall survival (105 vs 80 months, p < 0.001).

Among MSI-H patients (11% of the cohort), 15% received NAT. Immunotherapy use increased steadily, surpassing chemotherapy in 2022. Patients receiving neoadjuvant immunotherapy +/− chemotherapy demonstrated superior survival to chemotherapy alone (106 vs 85 months, p < 0.001).

CONCLUSIONS

Neoadjuvant therapy use has increased nationally, with a notable rise in immunotherapy for MSI-H tumors. Neoadjuvant treatment, particularly immunotherapy, is associated with significant overall survival benefit.

Abstract Image

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临床T4b结肠癌新辅助治疗的缓慢采用：国家癌症数据库分析。

背景：新出现的数据支持新辅助治疗（NAT）的使用，特别是微卫星不稳定性高（MSI-H）肿瘤的免疫治疗。我们评估了临床T4b结肠癌使用NAT的国家趋势及其与总生存期的关系，重点是MSI-H肿瘤。方法：我们使用国家癌症数据库（2010-2022）进行了一项回顾性队列研究，评估接受结肠切除术的非转移性临床T4b结肠腺癌患者。主要结局指标是NAT利用趋势和总生存率。结果：在8862例临床T4b结肠癌患者中，NAT利用率随着时间的推移而增加，在最近的四分位数中达到28%的峰值。NAT接受者更有可能更年轻、更健康，并在学术中心接受治疗。NAT与更高的R0切除率相关（83% vs 77%）。结论：新辅助治疗的使用在全国范围内有所增加，MSI-H肿瘤的免疫治疗显著增加。新辅助治疗，特别是免疫治疗，与显著的总体生存获益相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.