Prognostic factors and the role of adjuvant chemotherapy in post-curative surgery for dukes B and C colon cancers and survival outcomes

A Malaysian experience

Astrid Sinarti Hassan, Amaramalar Selvi Naicker, Khairul Hazdi Yusof, Wan Zamaniah Wan Ishak

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Adjuvant chemotherapy improves survival in Dukes C colon cancers post-curative resection. However, the evidence for a role with Dukes B lesions remains unproven despite frequent use for disease characterized by poor prognostic features. In view of limited Asia-specific data, this study aimed to determine survival outcomes and identify prognostic factors in a tertiary teaching hospital in Malaysia. Materials and Methods: A total of 116 subjects who underwent curative surgery with and without adjuvant chemotherapy for Duke B and C primary colon adenocarcinomas diagnosed from 2004-2009 were recruited and data were collected retrospectively. Five-year overall survival (OS) and disease free survival (DFS) were analysed using Kaplan-Meier survival analysis and log-rank (Mantel-Cox) test. Prognostic factors were determined using Cox proportional hazards regression with both univariate and multivariate analyses. Results: The survival analysis demonstrated a 5-year OS of 74.0% for all patients, with 74.9% for Dukes C subjects receiving chemotherapy compared to 28.6% in those not receiving chemotherapy (p=0.001). For Dukes B disease, the 5-year survival rate was 82.6% compared to 75.0% for subjects receiving and not receiving chemotherapy, respectively (p=0.17). Independent prognostic factors identified included a CEA level more than 3.5 ng/ml (hazard ratio (HR)=4.78; p=0.008), serosal involvement (HR=3.75; p=0.028) and completion of chemotherapy (HR= 0.20; p=0.007). Conclusions: In a regional context, this study supports current evidence from the West that adjuvant chemotherapy improves survival in Dukes C colon cancers post curative surgery. However, although a clear benefit has yet to be proven for Dukes B disease, our results suggest survival improvement in selected cases.

Original languageEnglish
Pages (from-to)2237-2243
Number of pages7
JournalAsian Pacific Journal of Cancer Prevention
Volume16
Issue number6
DOIs
Publication statusPublished - 2015

Fingerprint

Adjuvant Chemotherapy
Colonic Neoplasms
Survival
Drug Therapy
Survival Analysis
Malaysia
Kaplan-Meier Estimate
Tertiary Care Centers
Teaching Hospitals
Disease-Free Survival
Colon
Adenocarcinoma
Multivariate Analysis
Survival Rate

Keywords

  • Adjuvant chemotherapy
  • Colon cancer
  • Dukes B
  • Dukes C

ASJC Scopus subject areas

  • Epidemiology
  • Oncology
  • Public Health, Environmental and Occupational Health
  • Cancer Research

Cite this

Prognostic factors and the role of adjuvant chemotherapy in post-curative surgery for dukes B and C colon cancers and survival outcomes : A Malaysian experience. / Hassan, Astrid Sinarti; Selvi Naicker, Amaramalar; Yusof, Khairul Hazdi; Wan Ishak, Wan Zamaniah.

In: Asian Pacific Journal of Cancer Prevention, Vol. 16, No. 6, 2015, p. 2237-2243.

Research output: Contribution to journalArticle

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title = "Prognostic factors and the role of adjuvant chemotherapy in post-curative surgery for dukes B and C colon cancers and survival outcomes: A Malaysian experience",
abstract = "Background: Adjuvant chemotherapy improves survival in Dukes C colon cancers post-curative resection. However, the evidence for a role with Dukes B lesions remains unproven despite frequent use for disease characterized by poor prognostic features. In view of limited Asia-specific data, this study aimed to determine survival outcomes and identify prognostic factors in a tertiary teaching hospital in Malaysia. Materials and Methods: A total of 116 subjects who underwent curative surgery with and without adjuvant chemotherapy for Duke B and C primary colon adenocarcinomas diagnosed from 2004-2009 were recruited and data were collected retrospectively. Five-year overall survival (OS) and disease free survival (DFS) were analysed using Kaplan-Meier survival analysis and log-rank (Mantel-Cox) test. Prognostic factors were determined using Cox proportional hazards regression with both univariate and multivariate analyses. Results: The survival analysis demonstrated a 5-year OS of 74.0{\%} for all patients, with 74.9{\%} for Dukes C subjects receiving chemotherapy compared to 28.6{\%} in those not receiving chemotherapy (p=0.001). For Dukes B disease, the 5-year survival rate was 82.6{\%} compared to 75.0{\%} for subjects receiving and not receiving chemotherapy, respectively (p=0.17). Independent prognostic factors identified included a CEA level more than 3.5 ng/ml (hazard ratio (HR)=4.78; p=0.008), serosal involvement (HR=3.75; p=0.028) and completion of chemotherapy (HR= 0.20; p=0.007). Conclusions: In a regional context, this study supports current evidence from the West that adjuvant chemotherapy improves survival in Dukes C colon cancers post curative surgery. However, although a clear benefit has yet to be proven for Dukes B disease, our results suggest survival improvement in selected cases.",
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T1 - Prognostic factors and the role of adjuvant chemotherapy in post-curative surgery for dukes B and C colon cancers and survival outcomes

T2 - A Malaysian experience

AU - Hassan, Astrid Sinarti

AU - Selvi Naicker, Amaramalar

AU - Yusof, Khairul Hazdi

AU - Wan Ishak, Wan Zamaniah

PY - 2015

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N2 - Background: Adjuvant chemotherapy improves survival in Dukes C colon cancers post-curative resection. However, the evidence for a role with Dukes B lesions remains unproven despite frequent use for disease characterized by poor prognostic features. In view of limited Asia-specific data, this study aimed to determine survival outcomes and identify prognostic factors in a tertiary teaching hospital in Malaysia. Materials and Methods: A total of 116 subjects who underwent curative surgery with and without adjuvant chemotherapy for Duke B and C primary colon adenocarcinomas diagnosed from 2004-2009 were recruited and data were collected retrospectively. Five-year overall survival (OS) and disease free survival (DFS) were analysed using Kaplan-Meier survival analysis and log-rank (Mantel-Cox) test. Prognostic factors were determined using Cox proportional hazards regression with both univariate and multivariate analyses. Results: The survival analysis demonstrated a 5-year OS of 74.0% for all patients, with 74.9% for Dukes C subjects receiving chemotherapy compared to 28.6% in those not receiving chemotherapy (p=0.001). For Dukes B disease, the 5-year survival rate was 82.6% compared to 75.0% for subjects receiving and not receiving chemotherapy, respectively (p=0.17). Independent prognostic factors identified included a CEA level more than 3.5 ng/ml (hazard ratio (HR)=4.78; p=0.008), serosal involvement (HR=3.75; p=0.028) and completion of chemotherapy (HR= 0.20; p=0.007). Conclusions: In a regional context, this study supports current evidence from the West that adjuvant chemotherapy improves survival in Dukes C colon cancers post curative surgery. However, although a clear benefit has yet to be proven for Dukes B disease, our results suggest survival improvement in selected cases.

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