The oncologist · 2026
Added value of adjuvant chemotherapy in patients with node-positive pT1-2 colon cancer: a national SNAPSHOT analysis.
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Hanevelt Julia, de Groot Jan W B, Rademaker Eva, Zamaray Bobby, Brohet Richard M, Moons Leon M G, Vleggaar Frank P, Consten Esther C J, Tanis Pieter J, de Vos tot Nederveen Cappel Wouter H, van Westreenen Henderik L, Dutch Snapshot Research Group (DSRG), Dutch Complex Colon Cancer Initiative (DCCCI) and Collaborators Snapshot Registry
Аннотация
BACKGROUND: Patients with node-positive colon carcinoma commonly receive adjuvant chemotherapy, regardless the tumor's T-stage. However, early-stage tumors (pT1-2 CC) are largely underrepresented in landmark studies supporting this treatment. This study evaluates the application of adjuvant chemotherapy in those patients based on daily practice.
PATIENTS AND METHODS: Patients who underwent surgery for either pT1- or pT2-CC were identified from the nationwide SNAPSHOT database and stratified by age (<75 or ≥75 years). Competing risk regression and (cause-specific) Cox proportional hazard models identified factors associated with 5-year cumulative incidence of recurrence and overall survival (OS), respectively.
RESULTS: Lymph node metastases were found in 381 out of 2,312 (16.5%) patients, of whom 275 (72.2%) received adjuvant chemotherapy. The cumulative incidence of recurrence was 0.09 (95% CI 0.06-0.12) and 0.18 (95% CI 0.11-0.27) in patients who did or did not receive adjuvant chemotherapy, respectively (P = .007). In patients under 75, adjuvant chemotherapy was associated with significantly higher OS (91.3% vs 68.1%, P < .001). Corresponding OS probabilities in elderly patients (≥75 years) were 84.5% vs 55.1%, P = .003. After adjusting for confounding, this difference remained only significant in patients under 75: HRadj 0.5, 95% CI 0.1-0.7 and HRadj 0.5, 95% CI 0.2-1.3, respectively. The recurrence rate was not significantly different between patients receiving capecitabine/oxaliplatin (CapOx) and those on Capecitabine monotherapy (CIF 0.09, 95% CI 0.06-0.14 vs 0.05, 95% CI 0.01-0.16, P = .49).
CONCLUSION: Adjuvant chemotherapy is associated with reduced risk of recurrence in patients with node-positive pT1-2 CC. Advantages on OS could not be demonstrated in elderly pT1-2N1-2 patients.
PATIENTS AND METHODS: Patients who underwent surgery for either pT1- or pT2-CC were identified from the nationwide SNAPSHOT database and stratified by age (<75 or ≥75 years). Competing risk regression and (cause-specific) Cox proportional hazard models identified factors associated with 5-year cumulative incidence of recurrence and overall survival (OS), respectively.
RESULTS: Lymph node metastases were found in 381 out of 2,312 (16.5%) patients, of whom 275 (72.2%) received adjuvant chemotherapy. The cumulative incidence of recurrence was 0.09 (95% CI 0.06-0.12) and 0.18 (95% CI 0.11-0.27) in patients who did or did not receive adjuvant chemotherapy, respectively (P = .007). In patients under 75, adjuvant chemotherapy was associated with significantly higher OS (91.3% vs 68.1%, P < .001). Corresponding OS probabilities in elderly patients (≥75 years) were 84.5% vs 55.1%, P = .003. After adjusting for confounding, this difference remained only significant in patients under 75: HRadj 0.5, 95% CI 0.1-0.7 and HRadj 0.5, 95% CI 0.2-1.3, respectively. The recurrence rate was not significantly different between patients receiving capecitabine/oxaliplatin (CapOx) and those on Capecitabine monotherapy (CIF 0.09, 95% CI 0.06-0.14 vs 0.05, 95% CI 0.01-0.16, P = .49).
CONCLUSION: Adjuvant chemotherapy is associated with reduced risk of recurrence in patients with node-positive pT1-2 CC. Advantages on OS could not be demonstrated in elderly pT1-2N1-2 patients.