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Analysis of delay in adjuvant chemotherapy in locally advanced rectal cancer

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Abstract

Background

Adjuvant chemotherapy (AC) after neoadjuvant chemoradiation and surgical resection has been the standard of care for locally advanced rectal cancer. However, there are no evidence-based guidelines regarding the optimal timing of AC for rectal cancer. The objective of this study was to evaluate the effect of AC timing on overall survival for rectal cancer.

Methods

The National Cancer Database (NCDB) from 2004 to 2016 was queried for primary clinical stage II or III rectal cancer patients who had undergone neoadjuvant chemoradiation followed by surgery and AC. Patients were grouped based on AC initiation: early ≤ 4 weeks, intermediate 4–8 weeks, and delayed ≥ 8 weeks. The primary outcome was overall survival.

Results

We identified 8722 patients, of which 905 (10.4%) received early AC, 4621 (53.0%) intermediate AC, and 3196 (36.6%) delayed AC. Pathological lymph-node metastasis (ypN +) was positive in 73% of early AC, 74% intermediate AC, and 63% delayed AC (p < 0.05). The 5-year survival probability was 71.1% (95% CI 68–74%) for early AC, 73.2% (95% CI 72–75%) intermediate AC, and 65.8% (95% CI 64–68%) delayed AC (p < 0.001). Using Cox proportional hazard modeling, patients undergoing delayed AC had an associated decreased survival compared to patients receiving early AC (HR 1.18; 95% CI 1.028–1.353, p = 0.018) or intermediate AC (HR 1.28; 95% CI 1.179–1.395, p < 0.01).

Conclusions

Delay in AC administration may be associated with decreased 5-year survival. Compared to early or intermediate AC, patients in the delayed AC group were observed to have increased risk of death, despite having lower proportions with ypN + disease. Patients with higher socioeconomic and education status were more likely to receive early chemotherapy.

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Authors and Affiliations

  1. Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA

    C. A. Farzaneh, W. Q. Duong, J. C. Carmichael & M. J. Stamos

  2. Department of Surgery, New York Presbyterian Hospital–Weill Cornell College of Medicine, 525 E 68th Street, Box #172, New York, NY, 10065, USA

    A. Pigazzi & M. D. Jafari

  3. Department of Statistics, University of California, Irvine, Irvine, CA, USA

    F. Dekhordi-Vakil

  4. Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Orange, CA, USA

    F. Dayyani & J. A. Zell

Authors
  1. C. A. Farzaneh
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  2. A. Pigazzi
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  3. W. Q. Duong
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  4. J. C. Carmichael
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  5. M. J. Stamos
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Contributions

Farzaneh and Jafari had full access to all of the data in the study and take full responsibility for the integrity of the data and accuracy of the data analysis. Concept and design: Farzaneh, Pigazzi, and Jafari. Acquisition, analysis, or interpretation of data: Farzaneh, Pigazzi, and Jafari. Drafting of the manuscript: Farzaneh. Critical revision of the manuscript: all authors. Statistical analysis: Farzaneh and Dehkordi-Vakil. Administrative, technical, or material support: Farzaneh, Duong, and Jafari. Supervision: Pigazzi and Jafari.

Corresponding author

Correspondence to M. D. Jafari.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors report no conflicts of interest, financial, or otherwise.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Farzaneh, C.A., Pigazzi, A., Duong, W.Q. et al. Analysis of delay in adjuvant chemotherapy in locally advanced rectal cancer. Tech Coloproctol 27, 35–42 (2023). https://doi.org/10.1007/s10151-022-02676-z

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