Abstract
Purpose
The extent to which ≥ 70 year patients with colon cancer benefit from adjuvant chemotherapy in the presence of competing risks remains controversial.
Methods
18,937 patients ≥ 70 years with high-risk stage II and stage III colon cancer were retrospectively reviewed from SEER database. Propensity score matching (PSM) was used to adjust for potential baseline confounding. The nomograms were developed based on the competing model to describe the individual probability of colon cancer-specific death (CCSD) and non-CCSD. The subpopulation treatment-effect pattern plot (STEPP) was used to estimate the treatment-effect heterogeneity.
Results
In the high-risk stage II subgroup, compared to the non-recipients, the hazard ratios (HR) of overall mortality for recipients were 0.83 (P = 0.001). The subdistribution hazard ratio (SHR) of CCSD for receipts was 1.22 (P = 0.021). The SHR of non-CCSD was 0.63 (P < 0.001). In the stage III subgroup, compared to non-recipients, the HR of the overall mortality for the recipients was 0.62 (P < 0.001). The SHR of CCSD was 0.77 (P < 0.001). The SHR of non-CCSD was 0.58 (P < 0.001). The chemotherapy efficacy differed significantly by risk score of non-CCSD (non-CCSD-RS) (P < 0.001). Recipients with high non-CCSD-RS had a rate of CCSD comparative to that of non-recipients (SHR 0.90, P = 0.150) in the stage III subgroup.
Conclusions
A survival analysis based on the overall mortality did not correctly interpret the effect of chemotherapy. Adjuvant chemotherapy did not provide an additional benefit to patients with high-risk stage II or patients with stage III at high risk of non-cancer death.
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Funding
The research was supported by (1) Key Projects in the National Science & Technology Pillar Program during the 12th 5-Year Plan Period (2014BAI09B07) and (2) National Key R&D Program of China (2017YFC0908200).
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Author Dan Li declares that he has no conflict of interest. Author Chenhan Zhong declares that she has no conflict of interest. Author Xiujun Tang declares that she has no conflict of interest. Author Linzhen Yu declares that she has no conflict of interest. Author Kefeng Ding declares that he has no conflict of interest. Author Ying Yuan declares that she has no conflict of interest.
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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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No ethics approval was sought for this study by authors as data used were the National Cancer Institute’s Surveillance, Epidemiology, and End Result (SEER) database, which is a publicly available de-identified population-based database.
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Dan Li and Chenhan Zhong are co-first authors.
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Li, D., Zhong, C., Tang, X. et al. Competing nomograms help in the selection of elderly patients with colon cancer for adjuvant chemotherapy. J Cancer Res Clin Oncol 144, 909–923 (2018). https://doi.org/10.1007/s00432-018-2611-y
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DOI: https://doi.org/10.1007/s00432-018-2611-y