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Adjuvant Chemotherapy Versus Observation Following Resection for Patients With Nonmetastatic Poorly Differentiated Colorectal Neuroendocrine Carcinomas
- Source :
- Annals of Surgery. 274:e126-e133
- Publication Year :
- 2019
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2019.
-
Abstract
- OBJECTIVE The aim of this study was to determine whether adjuvant chemotherapy (AC) provides a survival benefit in patients with nonmetastatic poorly differentiated colorectal neuroendocrine carcinomas (CRNECs) following resection. BACKGROUND There is little evidence to support the association between use of AC and improved overall survival (OS) in patients with CRNECs. METHODS Patients with resected non-metastatic CRNECs were identified in the National Cancer Database (2004-2014). Inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare OS of patients in different treatment groups. RESULTS A total of 806 patients diagnosed between 2004 and 2014 met the study entry criteria. Of these, 394 patients (48.9%) received AC. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer for AC versus observation [57.4 (interquartile range, IQR, 14.8-153.8) vs 38.2 (IQR, 10.4-125.4) months; P = 0.007]. In IPTW-adjusted Cox proportional hazards regression analysis, AC was associated with a significant OS benefit [hazard ratio (HR) = 0.73, 95% confidence interval (CI) 0.64-0.84; P < 0.001]. The results were consistent across subgroups stratified by pathologic T stage, pathologic N stage, and surgical margin status. Subgroup analysis according to tumor location demonstrated improved OS in the adjuvant therapy cohort among patients with left-sided neuroendocrine carcinomas (HR, 0.55; 95% CI, 0.44-0.68), but not in those with right-sided disease (HR, 0.89; 95% CI, 0.74-1.07). CONCLUSIONS Patients with nonmetastatic CRNECs may derive survival benefit from AC. These findings support current guidelines recommending AC in patients with poorly differentiated neuroendocrine carcinomas in the colon and rectum. Efforts in education and adherence to national guidelines for NECs are needed.
- Subjects :
- Male
Oncology
medicine.medical_specialty
Surgical margin
Rectum
Observation
Subgroup analysis
03 medical and health sciences
0302 clinical medicine
Interquartile range
Internal medicine
Adjuvant therapy
Humans
Medicine
Registries
Aged
business.industry
Proportional hazards model
Hazard ratio
Middle Aged
United States
Carcinoma, Neuroendocrine
Survival Rate
medicine.anatomical_structure
Chemotherapy, Adjuvant
030220 oncology & carcinogenesis
T-stage
Female
030211 gastroenterology & hepatology
Surgery
Colorectal Neoplasms
business
Subjects
Details
- ISSN :
- 15281140 and 00034932
- Volume :
- 274
- Database :
- OpenAIRE
- Journal :
- Annals of Surgery
- Accession number :
- edsair.doi.dedup.....2906a0a34486abfaadc6b4e55be400b7