Real-World Evidence on Adjuvant Chemotherapy After Resection of Left-Sided Obstructive Colon Cancer

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2026-03-01 Epub Date: 2025-09-24 DOI:10.1016/j.clcc.2025.09.002

Bobby Zamaray , Jan Willem B. de Groot , Jeanin E. van Hooft , Niels F.M. Kok , Peter D. Siersema , Esther C.J. Consten , Pieter J. Tanis , Henderik L. van Westreenen , Dutch Snapshot Research Group and the Dutch Complex Colon Cancer Initiative (DCCCI)

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引用次数: 0

Abstract

Background

Bowel obstruction is considered a poor prognostic factor in colon cancer. Therefore, these patients are generally treated with adjuvant chemotherapy following resection of the primary tumour. However, the benefit of adjuvant chemotherapy in stage II obstructive colon cancer, and the impact of bridge-to-surgery strategies are insufficiently known.

Methods

This was a nationwide cohort study of patients who underwent resection of left-sided obstructive colon cancer (LSOCC) with curative intent in 75 hospitals between 2009 and 2016. Potential predictors for receiving adjuvant chemotherapy were included in a multivariable model. The impact of adjuvant chemotherapy on disease-free survival (DFS) and overall survival (OS), corrected for age, ASA-score, and 30-day postoperative complications, was determined using Cox regression analyses, with pTN stratification.

Results

Of 2151 included patients, 39.7% received adjuvant chemotherapy. Independent predictors of receiving adjuvant chemotherapy were age, ASA score, pT and pN1-2 categories, and Clavien-Dindo grade III-IV postoperative complications, but not a bridge-to-surgery strategy. Adjuvant chemotherapy was independently associated with better DFS (HR: 0.61; 95% CI, 0.51-0.72) and OS (HR: 0.49; 95% CI, 0.40-0.61) in the overall population. In pT3N0 LSOCC, adjuvant chemotherapy was not associated with DFS or OS. In patients with pT4N0 LSOCC however, adjuvant chemotherapy was associated with improved DFS (HR: 0.53, 95% CI, 0.29-0.95) and OS (HR: 0.42, 95% CI, 0.20-0.86). No differences in DFS or OS were observed between patients who received single-agent versus doublet chemotherapy were found.

Conclusion

A bridge-to-surgery strategy did not influence adjuvant chemotherapy receipt in patients with LSOCC. Obstruction is considered a risk factor in stage II, but no survival benefit of adjuvant chemotherapy is seen for the pT3N0 subgroup.

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左侧梗阻性结肠癌切除术后辅助化疗的真实世界证据。

背景：肠梗阻被认为是结肠癌预后不良的因素。因此，这些患者通常在原发肿瘤切除后进行辅助化疗。然而，辅助化疗对II期梗阻性结肠癌的益处以及手术过渡策略的影响尚不清楚。方法：这是一项全国性的队列研究，研究对象是2009年至2016年间在75家医院接受左侧梗阻性结肠癌（LSOCC）切除术的患者。接受辅助化疗的潜在预测因素包括在多变量模型中。使用Cox回归分析和pTN分层确定辅助化疗对无病生存期（DFS）和总生存期（OS）的影响，校正年龄、asa评分和术后30天并发症。结果：2151例患者中，39.7%接受了辅助化疗。接受辅助化疗的独立预测因素是年龄、ASA评分、pT和pN1-2分类以及Clavien-Dindo III-IV级术后并发症，但不是手术前的桥梁策略。辅助化疗与总体人群中更好的DFS （HR: 0.61; 95% CI, 0.51-0.72）和OS （HR: 0.49; 95% CI, 0.40-0.61）独立相关。在pT3N0 LSOCC中，辅助化疗与DFS或OS无关。然而，在pT4N0 LSOCC患者中，辅助化疗与改善的DFS （HR: 0.53, 95% CI, 0.29-0.95）和OS （HR: 0.42, 95% CI, 0.20-0.86）相关。接受单药与双药化疗的患者在DFS或OS方面没有差异。结论：手术过渡策略不影响LSOCC患者的辅助化疗接受情况。梗阻被认为是II期的一个危险因素，但pT3N0亚组没有看到辅助化疗的生存益处。

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

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.