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Neoadjuvant Chemotherapy Improves Survival in Patients with Clinical T4b Colon Cancer

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

In 2016, the National Comprehensive Cancer Network included neoadjuvant chemotherapy as a treatment option for patients with clinical T4b colon cancer. However, there is little published data on the survival impact of neoadjuvant chemotherapy for locally advanced colon cancer.

Methods

Adult patients with non-metastatic clinically staged T3 or T4 colon cancer who underwent surgical resection were identified from the National Cancer Data Base between 2006 and 2014. Treatment was categorized as neoadjuvant chemotherapy followed by surgery and surgery followed by adjuvant chemotherapy. Overall survival was compared between the two groups using propensity score matching.

Results

Of 27,575 patients that met inclusion criteria, 26,654 (97%) were treated with surgery followed by adjuvant chemotherapy and 921 (3%) received neoadjuvant chemotherapy followed by surgery. After propensity score matching, patients with T4b colon cancer treated with neoadjuvant chemotherapy had a 23% lower risk of death at 3 years compared to patients that had adjuvant chemotherapy (HR 0.77, 95% CI 0.60–0.98; p = 0.04). However, neoadjuvant chemotherapy did not demonstrate a similar significant benefit for patients with T3 and T4a disease.

Conclusions

Patients with clinical T4b colon cancer treated with neoadjuvant chemotherapy may have an improved survival compared to those who receive adjuvant chemotherapy. Further prospective investigation is warranted.

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Authors and Affiliations

  1. John Wayne Cancer Institute at Providence St John’s Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA

    Ahmed Dehal, Amanda N. Graff-Baker, Brooke Vuong, Trevan Fischer, Anton J. Bilchik & Melanie Goldfarb

  2. The Angeles Clinic and Research Institute, Los Angeles, CA, USA

    Samuel J. Klempner

  3. Providence Health & Services, Medical Data Research Center, Portland, OR, USA

    Shu-Ching Chang & Gary L. Grunkemeier

Authors
  1. Ahmed Dehal
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  2. Amanda N. Graff-Baker
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  3. Brooke Vuong
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  4. Trevan Fischer
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  5. Samuel J. Klempner
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  6. Shu-Ching Chang
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  7. Gary L. Grunkemeier
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  8. Anton J. Bilchik
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  9. Melanie Goldfarb
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Contributions

Conception of the work: Ahmed Dehal

Data acquisition: All authors

Data analysis: All authors

Data interpretation: All authors

Manuscript drafting and Final approval: All authors

Corresponding author

Correspondence to Melanie Goldfarb.

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Cite this article

Dehal, A., Graff-Baker, A.N., Vuong, B. et al. Neoadjuvant Chemotherapy Improves Survival in Patients with Clinical T4b Colon Cancer. J Gastrointest Surg 22, 242–249 (2018). https://doi.org/10.1007/s11605-017-3566-z

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  • DOI: https://doi.org/10.1007/s11605-017-3566-z

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