Chemotherapy: Open Access
Open Access

Abstract

“Real World” Effectiveness of Different Postoperative Adjuvant Chemotherapy Regimens in Stage III Colon Cancer Patients

Chiang JM, Hung HY, Chiang SF, You JF, Pao-Shiu Hsieh and Chien-Yuh Yeh

Background: The benefit of oxaliplatin as postoperative adjuvant chemotherapy in the real world practice remained further clarified. Clinically, choosing oral 5-FU drug or FOLFOX regimen may depend to drug toxicity and patient’s age and comorbidities.

Methods: Patients included in this study was from Chang Gung Memorial Hospital (CGMH) colorectal cancer registry database. Treatment outcomes were compared based on the type of chemotherapy in terms of OS and DFS. Multivariate Cox-regression modelling was used to adjust for the potential confounders.

Results: Between 2007 Jan and 2012 Dec, 688 stage III colon cancer patients were collected including fluorouracil-leucovorin plus oxaliplatin (FOLFOX-6) (283 patients), Capecitabine (259 patients), and Tegafur-uracil (146 patients). Patients receiving FOLFOX-6 were significantly younger (mean age 56.5 yrs vs 65,1 yrs and 66,9 yrs ), more poor differentiation (15.9% vs 8.1% and 8.2%), deeper tumor invasion (T4 lesion 25.1% vs 15.8% and 17.1%), more advanced nodal involvement (N2/3 51.9% vs 18.1% and 20.5%) and had less comorbidity (50.2% vs 61.4% and 65.1%). Rate of completeness of chemotherapies (88.0% vs 87.6% and 81.5%) was no significant difference. Treatment outcome, by balancing confounding factors including co-morbidities, multivariate analysis showed that impact on OS in patients receiving FOLFOX-6 regimen was no difference comparing with capecitabine (HR=1.32, p=0.32) while Tegafur-uracil was statistically significant worse than Tegafur (HR=1.69, p=0.03). However, disease free survival (DFS) was no significantly different for FOLFOX-6 (HR 0.97, p=0.88) and Tegafur (HR 1.08, p=0.72) comparing with capecitabine.

Conclusions: In this retrospective study, as post-operative adjuvant setting, we found oral chemotherapy (Capecitabine or UFUR) compared with FOLFOX-6 for stage III colon cancer patients demonstrated similar DFS after balancing bias on imbalanced use of oxaliplatin-based chemotherapy.