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Adjuvant chemotherapy for stage III colon cancer: Relative dose intensity and survival among veterans

Aspinall, SL and Good, CB and Zhao, X and Cunningham, FE and Heron, BB and Geraci, M and Passero, V and Stone, RA and Smith, KJ and Rogers, R and Shields, J and Sartore, M and Boyle, DP and Giberti, S and Szymanski, J and Smith, D and Ha, A and Sessions, J and Depcinski, S and Fishco, S and Molina, I and Lepir, T and Jean, C and Cruz-Diaz, L and Motta, J and Calderon-Vargas, R and Maland, J and Keefe, S and Tague, M and Leone, A and Glovack, B and Kaplan, B and Cosgriff, S and Kaster, L and Tonnu-Mihara, I and Nguyen, K and Carmichael, J and Clifford, L and Lu, K and Chatta, G (2015) Adjuvant chemotherapy for stage III colon cancer: Relative dose intensity and survival among veterans. BMC Cancer, 15 (1).

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Background: Given the paucity of information on dose intensity, the objective of this study is to describe the use of adjuvant chemotherapy for stage III colon cancer, focusing on relative dose intensity (RDI), overall survival (OS) and disease-free survival (DFS). Methods: Retrospective cohort of 367 patients diagnosed with stage III colon cancer in 2003-2008 and treated at 19 VA medical centers. Kaplan-Meier curves summarize 5-year OS and 3-year DFS by chemotherapy regimen and RDI, and multivariable Cox proportional hazards regression was used to model these associations. Results: 5-fluorouracil/leucovorin (FU/LV) was the most commonly initiated regimen in 2003 (94.4%) and 2004 (62.7%); in 2005-2008, a majority of patients (60%-74%) was started on an oxaliplatin-based regimen. Median RDI was 82.3%. Receipt of >70% RDI was associated with better 5-year OS (p<0.001) and 3-year DFS (P=0.009) than was receipt of ≤70% RDI, with 5-year OS rates of 66.3% and 50.5%, respectively and 3-year DFS rates of 66.1% and 52.7%, respectively. In the multivariable analysis of 5-year OS, oxaliplatin+5-FU/LV (versus 5-FU/LV) (HR=0.55; 95% CI=0.34-0.91), >70% RDI at the first year (HR=0.58; 95% CI=0.37-0.89) and married status (HR=0.66; 95% CI=0.45-0.97) were associated with significantly decreased risk of death, while age ≥75 (versus 55-64) (HR=2.06; 95% CI=1.25-3.40), Charlson Comorbidity Index (HR=1.17; 95% CI=1.06-1.30), T4 tumor status (versus T1/T2) (HR=5.88; 95% CI=2.69-12.9), N2 node status (HR=1.68; 95% CI=1.12-2.50) and bowel obstruction (HR=2.32, 95% CI=1.36-3.95) were associated with significantly increased risk. Similar associations were observed for DFS. Conclusion: Patients with stage III colon cancer who received >70% RDI had improved 5-year OS. The association between RDI and survival needs to be examined in studies of adjuvant chemotherapy for colon cancer outside of the VA.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Aspinall, SLaspinall@pitt.eduASPINALL
Good, CBcbg15@pitt.eduCBG15
Zhao, X
Cunningham, FE
Heron, BB
Geraci, M
Passero, V
Stone, RAroslyn@pitt.eduROSLYN
Smith, KJkjs8@pitt.eduKJS8
Rogers, R
Shields, J
Sartore, M
Boyle, DP
Giberti, S
Szymanski, J
Smith, D
Ha, A
Sessions, J
Depcinski, S
Fishco, S
Molina, I
Lepir, T
Jean, C
Cruz-Diaz, L
Motta, J
Calderon-Vargas, R
Maland, J
Keefe, S
Tague, M
Leone, A
Glovack, B
Kaplan, B
Cosgriff, S
Kaster, L
Tonnu-Mihara, I
Nguyen, K
Carmichael, J
Clifford, L
Lu, K
Chatta, G
Date: 18 February 2015
Date Type: Publication
Journal or Publication Title: BMC Cancer
Volume: 15
Number: 1
DOI or Unique Handle: 10.1186/s12885-015-1038-y
Schools and Programs: School of Medicine > Medicine
School of Pharmacy > Pharmaceutical Sciences
Refereed: Yes
Date Deposited: 22 Dec 2016 15:37
Last Modified: 30 Mar 2021 14:55


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