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NEOADJUVANT CHEMOTHERAPY IMPROVES SURVIVAL IN PATIENTS WITH CLINICAL T4B COLON CANCER
Ahmed Dehal*1, Brooke Vuong1, Amanda Graff-Baker1, Trevan Fischer1, Samuel J. Klempner2, Mark Faries1, Anton J. Bilchik1, Shu-Ching Chang3, Gary L. Grunkemeier3, Melanie Goldfarb1
1John Wayne Cancer Institute at Providence St John’s Health Center, , Santa monica, CA; 2The Angeles Clinic and Research Institute, Los Angeles, CA; 3Providence Health & Services, Portland, OR
Background: Complete oncological resection followed by adjuvant chemotherapy (AC) is the standard approach for patients with locally advanced colon cancer (LACC). However, complete resection of LACC often requires extensive en bloc removal to achieve R0 margins. Neoadjuvant chemotherapy (NAC) is a novel therapeutic approach in selected patients with LACC, and in 2016, the NCCN included NAC as a treatment option for patients with clinical T4b disease. Our objective was to examine the role of NAC in the treatment of patients with LACC using a large national database.
Methods: Adult patients with non-metastatic clinical T3 or T4 colon cancer (CC) who underwent surgery were identified from the National Cancer Data Base between 2006 and 2013. Treatment was categorized as NAC followed by surgery and surgery followed by AC. Primary endpoint was overall survival (OS). Univariate Cox regressions as well as propensity score matching were used. The two groups were matched for patient demographics, comorbidity, hospital characteristics, grade, histology, surgical procedure, nodal disease, and nodal retrieval.
Results: Of 26,816 patients who met inclusion criteria, 25,761 (96%) were treated with surgery followed by AC and 1,055 (4%) received NAC followed by surgery. In univariate analysis, patients with T3 disease treated with NAC had a decreased OS compared to those who received AC (HR: 1.24, 95% CI: 1.05-1.48 p 0.01), whereas those with T4b disease had an improved OS (HR: 0.68, 95% CI: 0.49-0.95 p 0.02). After propensity score matching, decreased OS among patients with T3 disease (HR 1.56, 95% CI: 1.27-1.91, P 〈 0.001) and improved OS among those with T4b disease (HR 0.66, 95% CI: 0.46-0.97, P 0.03) remained significant. There was no difference in OS between the treatment groups for patients with T4a disease in any of the analyses.
Conclusions: This is the first national study to examine the role of NAC in LACC. Patients with T4b CC who were treated with NAC may have an improved OS when compared to those who received AC. Further prospective investigation is warranted.
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