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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

World Journal of Surgery volume 40, pages 447–455 (2016)Cite this article

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.

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Acknowledgments

The NCDB is a Joint Project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB participant user file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods or the conclusions drawn from these data by the investigators. This work has been supported indirectly by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and by the Mayo School of Graduate Medical Education Clinician Investigator Program. No specific grant number is associated with the work.

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Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    J. R. Bergquist, C. A. Thiels, C. R. Shubert & M. D. Zielinski

  2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    J. R. Bergquist, C. A. Thiels, C. R. Shubert, E. B. Habermann & M. D. Zielinski

  3. Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, OR, USA

    A. V. Hayman

  4. Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA

    M. D. Zielinski

  5. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    K. L. Mathis

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  1. J. R. Bergquist
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Bergquist, J.R., Thiels, C.A., Shubert, C.R. et al. 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. World J Surg 40, 447–455 (2016). https://doi.org/10.1007/s00268-015-3319-7

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  • DOI: https://doi.org/10.1007/s00268-015-3319-7

Keywords

  • Rectal Cancer
  • Adjuvant Therapy
  • Additional Therapy
  • National Comprehensive Cancer Network Guideline
  • National Cancer Data Base