Adjuvant Chemotherapy for Stage III Colon Cancer: Implications of Race/Ethnicity, Age, and Differentiation

• Published in: JAMA : the journal of the American Medical Association 2005-12, Vol.294 (21), p.2703-2711
• Main Authors: Jessup, J. Milburn, Stewart, Andrew, Greene, Frederick L, Minsky, Bruce D
• Format: Article
• Language: English
• Subjects: Adjuvants, Immunologic - therapeutic use; Age Factors; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - therapeutic use; Biological and medical sciences; Black or African American; Black People - statistics & numerical data; Chemotherapy; Chemotherapy, Adjuvant - statistics & numerical data; Clinical outcomes; Colonic Neoplasms - drug therapy; Colonic Neoplasms - ethnology; Colonic Neoplasms - mortality; Colonic Neoplasms - pathology; Colorectal cancer; Drug Utilization; Female; Fluorouracil - therapeutic use; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Levamisole - therapeutic use; Male; Medical sciences; Middle Aged; Neoplasm Staging; Polls & surveys; Prognosis; Proportional Hazards Models; Race; Sex Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; Tumors; United States; White People - statistics & numerical data
• ISSN: 0098-7484; 1538-3598; 1538-3598
• DOI: 10.1001/jama.294.21.2703

CONTEXT A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy because survival was improved in clinical trials in patients who received a 5-fluorouracil–based regimen. OBJECTIVE To determine whether adjuvant chemotherapy is used in the community as a standard of practice that improves outcome and whether it failed to benefit any specific sets of patients. DESIGN, SETTING, AND PARTICIPANTS Prospective data from 85 934 patients with stage III colon cancer from 560 hospital cancer registries were entered into the National Cancer Data Base between 1990 and 2002 and included standard clinical, pathological, and first course of treatment variables. MAIN OUTCOME MEASURES Prevalence of adjuvant chemotherapy usage and 5-year survival in patients treated in US hospitals. RESULTS Adjuvant chemotherapy use increased from 39% in 1991 to 64% in 2002 but was lower in black, female, and elderly patients. It improved 5-year survival from almost 8% in 1991 to more than 16% in 1997 compared with surgery alone. Adjuvant chemotherapy increases survival in elderly patients as much as it does in younger patients. However, the benefit of adjuvant chemotherapy in blacks and those with high-grade cancers is not as great. CONCLUSIONS Adjuvant chemotherapy use has increased from 1990 to 2002 for patients with stage III colon cancer with an associated increase in 5-year survival of 16%. The benefit of adjuvant chemotherapy seems to be lower in black patients and high-grade cancers. Women have the same benefit but are less often treated. Elderly patients have the same benefit as younger patients but are less frequently treated. New options for adjuvant therapy in 2004-2005 may further improve the outcome of patients with stage III colon cancer.