Abstract
Purpose
To clarify whether the combination of age and high-risk factors (HRFs) was preferable for adjuvant chemotherapy (AC) decision-making in patients with stage II colon adenocarcinoma.
Methods
We conducted a retrospective study analyzing eligible colon cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017. A nomogram was used to predict patient prognosis. Decision curve analysis (DCA) predicted model clinical benefit. Restricted cubic spline calculated the optimal cut-off value.
Results
A total of 8570 patients with stage II colon adenocarcinoma were included in this study; 25.2% received AC. A nomogram predicting the prognosis of patients with stage II colon adenocarcinoma was constructed with age and HRFs, and scores were assigned to the relevant variables. DCA showed that age combined with HRFs was superior to treatment decision-making based on HRFs alone. Patients were grouped according to their total score with the cut-off value of 100. AC did not significantly improve overall survival (OS) in low-score group (hazard ratios (HRs) 1.01, 95% confidence intervals (CIs) 0.86–1.18, p = 0.918). In high-score group, AC improved 5-year OS by about 7.6% (HR 0.73, 95% CI 0.61–0.88, p = 0.001). And high-score group mainly included patients aged < 50 years with two or more HRFs and patients aged ≥ 50 years with at least one HRF.
Conclusion
Age and HRFs could be preferable for determining the group of stage II colon adenocarcinoma patients who would benefit from AC. Patients aged < 50 years with two or more HRFs might be a potential benefit population for AC.
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Data availability
The data in this study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database (https://seer.cancer.gov/). And clinical data were obtained by the software SEER*Stat 8.4.2.
References
Siegel RL, Wagle NS, Cercek A et al (2023) Colorectal cancer statistics, 2023. CA Cancer J Clin 73(3):233–254
Gunderson LL, Jessup JM, Sargent DJ et al (2010) Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol 28(2):264–271
Baxter NN, Kennedy EB, Bergsland E et al (2022) Adjuvant therapy for stage II colon cancer: ASCO Guideline Update. J Clin Oncol 40(8):892–910
O’Connor ES, Greenblatt DY, LoConte NK et al (2011) Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol 29(25):3381–3388
Kumar A, Kennecke HF, Renouf DJ et al (2015) Adjuvant chemotherapy use and outcomes of patients with high-risk versus low-risk stage II colon cancer. Cancer 121(4):527–534
Verhoeff SR, van Erning FN, Lemmens VEPP et al (2016) Adjuvant chemotherapy is not associated with improved survival for all high-risk factors in stage II colon cancer. Int J Cancer 139(1):187–193
Hajirawala LN, Yi Y, Herritt BC et al (2022) Multiple high-risk features for stage II colon carcinoma portends worse survival than stage III disease. Dis Colon Rectum 66(8):1076–1084
Argilés G, Tabernero J, Labianca R et al (2020) Localised colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 31(10):1291–1305
Babcock BD, Aljehani MA, Jabo B et al (2018) High-risk stage II colon cancer: not all risks are created equal. Ann Surg Oncol 25(7):1980–1985
Hagerty BL, Aversa JG, Dominguez DA et al (2022) Age determines adjuvant chemotherapy use in resected stage II colon cancer. Dis Colon Rectum 65(10):1206–1214
Kneuertz PJ, Chang GJ, Hu CY et al (2015) Overtreatment of young adults with colon cancer. JAMA Surg 150(5)
Adamo M, Groves C, Dickie L et al (2023) SEER program coding and staging manual 2023. In: U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute. https://seer.cancer.gov/tools/codingmanuals/
Birkett RT, Chamely E, Concors SJ et al (2019) Overuse and limited benefit of chemotherapy for stage II colon cancer in young patients. Clin Colorectal Cancer 18(4):292–300
Yang L, Chen X, Lee C et al (2023) Functional characterization of age-dependent p16 epimutation reveals biological drivers and therapeutic targets for colorectal cancer. J Exp Clin Cancer Res 42(1)
Turrell FK, Orha R, Guppy NJ et al (2023) Age-associated microenvironmental changes highlight the role of PDGF-C in ER+ breast cancer metastatic relapse. Nat Cancer 4(4):468–484
Zahed H, Feng X, Sheikh M et al (2023) Age at diagnosis for lung, colon, breast and prostate cancers: An international comparative study. Int J Cancer 154(1):28–40
Han S, Georgiev P, Ringel AE et al (2023) Age-associated remodeling of T cell immunity and metabolism. Cell Metab 35(1):36–55
Network NCC. NCCN Clinical practice guidelines in oncology (NCCN Guidelines®) Colon Cancer Version 1.2023. https://www.nccn.org/
Liu LL, Xiang ZL (2022) Adjuvant chemotherapy improves survival in high-risk stage II colon cancer: a retrospective cohort study. Therap Adv Gastroenterol 15
Ginesi MC, Bliggenstorfer JT, Kwesiga DM et al (2023) Factors associated with receipt of adjuvant chemotherapy in stage II colon cancer. Ann Surg Oncol. https://doi.org/10.1245/s10434-023-13631-z
Tie J, Cohen JD, Lahouel K et al (2022) Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer. N Engl J Med 386(24):2261–2272
Boeken T, Blons H, Dean C et al (2023) The potential of ctDNA in locoregional therapies for colorectal cancer. Lancet Gastroenterol Hepatol 8(12):1072–1073
Schøler LV, Reinert T, Ørntoft M-BW et al (2017) Clinical implications of monitoring circulating tumor DNA in patients with colorectal cancer. Clin Cancer Res 23(18):5437–5445
Loft M, To YH, Gibbs P et al (2023) Clinical application of circulating tumour DNA in colorectal cancer. Lancet Gastroenterol Hepatol 8(9):837–852
Funding
This work was supported by the General Research Project of Zhejiang Provincial Department of Education (Y202248750).
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PZ: Data curation, formal analysis, visualization, funding acquisition, writing (original draft), writing (review and editing). CY: Data curation, formal analysis, investigation, software, validation. HL: Formal analysis, visualization, investigation, methodology. XG: Formal analysis, writing (review and editing), supervision. HH: Conceptualization, writing (review and editing), supervision, project administration, resources. All authors reviewed the manuscript.
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Zheng, P., Ye, C., Liu, H. et al. Adjuvant chemotherapy decision-making in stage II colon adenocarcinoma associated with patients’ age and high-risk factors. Int J Colorectal Dis 39, 3 (2024). https://doi.org/10.1007/s00384-023-04581-9
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DOI: https://doi.org/10.1007/s00384-023-04581-9