Neoadjuvant chemotherapy in patients undergoing colonic resection for locally advanced nonmetastatic colon cancer: A nationwide propensity score matched cohort study
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Neoadjuvant chemotherapy in patients undergoing colonic resection for locally advanced nonmetastatic colon cancer : A nationwide propensity score matched cohort study. / Laursen, Magnus; Dohrn, Niclas; Gögenur, Ismail; Klein, Mads Falk.
I: Colorectal Disease, Bind 24, Nr. 8, 2022, s. 954-964.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Neoadjuvant chemotherapy in patients undergoing colonic resection for locally advanced nonmetastatic colon cancer
T2 - A nationwide propensity score matched cohort study
AU - Laursen, Magnus
AU - Dohrn, Niclas
AU - Gögenur, Ismail
AU - Klein, Mads Falk
N1 - Publisher Copyright: © 2022 Association of Coloproctology of Great Britain and Ireland.
PY - 2022
Y1 - 2022
N2 - Aim: Neoadjuvant chemotherapy (NCT) for nonmetastatic colon cancer is not routinely used, and is currently only recommended as a treatment option for a subgroup of patients with T4b colon cancers in clinical guidelines. However, NCT may cause downstaging of the tumour, increase resectability, eradicate micrometastases and thereby improve long-term outcomes for patients with nonmetastatic colon cancer. The aim of this study was to investigate the short-term postoperative outcomes in a nationwide cohort of patients with locally advanced colon cancer (LACC) receiving NCT. Method: Using the Danish Colorectal Cancer Group Database, data were retrieved on patients diagnosed with LACC (defined as clinical T3 with extramural tumour invasion >5 mm or T4) and treated with resection with a curative intent between 2015 and 2019. Propensity score matching (PSM) in a 1:1 ratio was performed to compare short-term surgical and oncological outcomes in patients receiving NCT with patients operated on without receiving NCT. Results: A total of 179 LACC patients were treated with NCT and 1131 were not. After PSM, 145 patients remained in each group. We found no significant differences in any short-term postoperative outcomes between the two groups. We found significant differences in favour of NCT regarding radicality and pathological N category [86% vs. 81% R0 (P = 0.029) and 51% vs. 46% pN0 (P = 0.017), respectively]. Conclusion: Neoadjuvant chemotherapy for LACC does not result in worse short-term postoperative outcomes and may increase the R0 rate as well as node-negative disease. Results on long-term benefits including survival are awaited from several ongoing randomized controlled trials.
AB - Aim: Neoadjuvant chemotherapy (NCT) for nonmetastatic colon cancer is not routinely used, and is currently only recommended as a treatment option for a subgroup of patients with T4b colon cancers in clinical guidelines. However, NCT may cause downstaging of the tumour, increase resectability, eradicate micrometastases and thereby improve long-term outcomes for patients with nonmetastatic colon cancer. The aim of this study was to investigate the short-term postoperative outcomes in a nationwide cohort of patients with locally advanced colon cancer (LACC) receiving NCT. Method: Using the Danish Colorectal Cancer Group Database, data were retrieved on patients diagnosed with LACC (defined as clinical T3 with extramural tumour invasion >5 mm or T4) and treated with resection with a curative intent between 2015 and 2019. Propensity score matching (PSM) in a 1:1 ratio was performed to compare short-term surgical and oncological outcomes in patients receiving NCT with patients operated on without receiving NCT. Results: A total of 179 LACC patients were treated with NCT and 1131 were not. After PSM, 145 patients remained in each group. We found no significant differences in any short-term postoperative outcomes between the two groups. We found significant differences in favour of NCT regarding radicality and pathological N category [86% vs. 81% R0 (P = 0.029) and 51% vs. 46% pN0 (P = 0.017), respectively]. Conclusion: Neoadjuvant chemotherapy for LACC does not result in worse short-term postoperative outcomes and may increase the R0 rate as well as node-negative disease. Results on long-term benefits including survival are awaited from several ongoing randomized controlled trials.
KW - colon cancer
KW - nationwide cohort study
KW - neoadjuvant chemotherapy
KW - propensity score matching
KW - short-term outcomes
U2 - 10.1111/codi.16116
DO - 10.1111/codi.16116
M3 - Journal article
C2 - 35285992
AN - SCOPUS:85127453227
VL - 24
SP - 954
EP - 964
JO - Colorectal Disease
JF - Colorectal Disease
SN - 1462-8910
IS - 8
ER -
ID: 314065856