scholarly journals Treatment results of colorectal cancer: 10-years series of UMC Ljubljana (1991-2000)

2006 ◽  
Vol 53 (2) ◽  
pp. 103-107
Author(s):  
Z. Stor ◽  
R. Juvan ◽  
F. Jelenc ◽  
S. Repse
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Survival Rate ◽  
Postoperative Mortality ◽  
Radical Resection ◽  
Stage Iii ◽  
Rank Test ◽  
R0 Resection ◽  
Colorectal Cancer Patients

In Slovenia the incidence of colorectal cancer is growing rapidly. In 1998 1022 new cases were registered. Our study compares results of two groups of patients with colorectal cancer. Patients and methods. In the period from 1.1.1991 to 31.12.2000 1478 patients with a colorectal carcinoma underwent potentially curative resection. We divided them in two groups, one operated in the first 5-years and second in later 5-years period. 5- years survival was estimated with Kaplan-Meier statistical analysis. Patients who died within 30 days after the operation were censored. Differences in survival curves between both groups were assessed by the log rank test. Results. We resected 1478 /1599 (92,4%) patients. There was 913 (61,7%) patients resected with colon cancer and 528 (35,8%) with rectal cancer and 37 (2,5%) with sinhronius tumors. R0 resection was performed in 1174 (79,4%) patients, R1 in 29 (2,0%), and R2 in 273 (18,5%) patients. Postoperative mortality rate in resected patients was 5,48% (81/1478), in the group with paliative operations was 17,35% (21/121). Overall five-years survival rate was 54,9% (56,18% for colon cancer and 52,4% for rectal cancer Five years survival rate for the patients with radical resection (R0) was 66,54% for colon cancer and 59,47% for rectal cancer. Conclusion. 5-years survival for R0-resected patients with colon cancer was in the last period from 1996 to 2000 statistically significantly better compared with the period from 1991 to 1995 (76% vs 60%) in stage I (p=0,04048) and in stage III (p=0,01842). 5-years survival for R0-resected patients with rectal cancer was significantly better in the same period (63% vs 55%) (p= 0,03627) in stage III (p=0,01663).

Adjuvant treatment in extreme elderly patients with colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 784-784
Author(s):  
Marta Llopis Cuquerella ◽  
Maria del Carmen Ors Castaño ◽  
María Ballester Espinosa ◽  
Alejandra Magdaleno Cremades ◽  
Vicente Boix Aracil ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Stage Ii ◽  
Stage Iii ◽  
Complementary Treatment ◽  
Colorectal Cancer Patients

784 Background: Surgical and adjuvant treatment in extreme elderly ( > 80 years) patients with localized colorectal cancer is an unresolved issue. Owing to the lack of available neither clinical practice nor investigational data in this field we present our experience in this scenario. Methods: We retrospectively reviewed data regarding surgical and complementary treatment for colorectal cancer patients aged more than 80 consecutively attended by General Surgery Department in Vega Baja Hospital between 2008 and 2013. Results: A total number of 115 colorectal cancer patients were registered. 95 patients diagnosed of localized disease were selected for analysis. Colon vs rectal cancer ratio was 4:1. Median age was 83.6 years (80-94). Male sex was predominant (60 patients, 63.2%). Emergency surgery was performed in 15 patients (15.8%). Complementary treatment to surgery was advised, according to international guidelines, in 53 patients (55.8%). 10 patients (18.9%) with an advise of adjuvant treatment finally received it. More patients with rectal cancer received recommended treatment (41.7% rectal vs 12.2% colon cancer). Patients with stage III disease were more frequently finally treated according to guidelines (22.2 % stage III vs 11.8% stage II). More patients with stage II rectal cancer were advised and received treatment (recommendation: 66.7% rectal vs 36.1% colon cancer; administration: 25% rectal vs 7.7% colon cancer). Treatment was also more frequently administered to stage III rectal cancer (50% rectal vs 14.3% rectal cancer) (Table). Conclusions: Our experience in localized colorectal cancer in extreme elderly patients ( > 80 years) showed that, although advised according to guidelines, most of them did not receive adjuvant treatment to surgery. Complementary treatment administration was more common in rectal cancer patients and with more advanced disease. [Table: see text]

scholarly journals Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Elena Orsenigo ◽  
Giulia Gasparini ◽  
Michele Carlucci
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Rank Test ◽  
Lymph Node Yield ◽  
Log Rank Test ◽  
Lymph Node Retrieval

Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08±11.4, 20.34±11.8, and 15.33±9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes (P=0.002, log-rank test). Rectal cancer patients with 12 or more lymph nodes removed approached but did not reach a statistically different survival (P=0.055, log-rank test). Multiple tumor and patients’ factors are associated with lymph node yield, but only the removal of at least 12 lymph nodes will reliably determine lymph node status.

Adjuvant chemotherapy with uracil-tegafur (UFT) for stage III colorectal cancer: Final results of randomized trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4049-4049 ◽  
Author(s):  
T. Hamaguchi ◽  
K. Shirao ◽  
Y. Moriya ◽  
S. Yoshida ◽  
S. Kodaira ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Hazard Ratio ◽  
Stage Iii ◽  
Control Group ◽  
Significant Difference ◽  
Resected Stage

4049 Background: In the latter 1990s, no consensus was reached as to whether adjuvant chemotherapy was standard treatment for completely resected stage III colorectal cancer in Japan. At that time, we started two randomized controlled trials to clarify the role of adjuvant chemotherapy of stage III colon and rectal cancer in the same time. Methods: Patients with completely resected stage III cancer of the colon or rectum (PS, 0 to 2; age, 20 to 75 years; no other adjuvant therapy) were eligible for these trials. Patients were registered within 6 weeks after surgery and were randomly assigned to receive surgery alone (control group) or surgery followed by treatment with UFT (400 mg/m2/day), given for 5 consecutive days per week for 1 year (UFT group). The target number of patients was 500 for colon cancer and 400 for rectal cancer (hazard ratio = 0.67, one-sided a= 0.05, β= 0.2). The primary endpoint was relapse-free survival (RFS), and the secondary end point was overall survival (OS). Results: Between October 1996 and April 2001, a total of 334 patients with colon cancer and 276 with rectal cancer were enrolled. Four ineligible patients were excluded; data from the remaining 332 patients with colon cancer and 274 with rectal cancer were analyzed. The patients’ characteristics were similar in the groups. Analysis of the results of follow-up until March 2006, at least 5 years after surgery in all patients (median follow-up period, 6.2 years), showed no significant difference in RFS or OS in colon cancer. In rectal cancer, however, RFS and OS were significantly better in the UFT group than in the control group. The only grade 4 toxicity was diarrhea, occurring in 1 patient with colon cancer and 1 patient with rectal cancer. Conclusions: Postoperative adjuvant chemotherapy with UFT is well tolerated and improved RFS and OS in patients with stage III rectal cancer. In colon cancer, the expected benefits were not obtained (hazard ratio = 0.67). [Table: see text] No significant financial relationships to disclose.

scholarly journals Plasma Prokineticin 1, a prognostic biomarker in colorectal cancer patients with curative resection: a retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Noriyuki Tagai ◽  
Takanori Goi ◽  
Michiaki Shimada ◽  
Hidetaka Kurebayashi
Keyword(s):  
Colorectal Cancer ◽  
Survival Rate ◽  
Cancer Patients ◽  
Curative Resection ◽  
Angiogenic Factor ◽  
Stage Iii ◽  
Primary Cancer ◽  
Colorectal Cancer Patients ◽  
Cancer Lesion ◽  
Related Survival

Abstract Background Prokineticin 1 (PROK1) was reported as an angiogenic factor, which is associated with tumor progression, cell invasion, and metastasis in colorectal cancer. Although the association between PROK1 expression in primary cancer lesion and patient prognosis was reported, it is unclear whether plasma PROK1 concentration may be a predictive factor in colorectal cancer patients. This study investigated the association between PROK1 concentration in plasma and prognosis in colorectal cancer patients. Methods We measured preoperative PROK1 plasma levels using ELISA method, while PROK1 expression in primary cancer lesion was evaluated using immunohistochemistry (IHC). The association between plasma PROK1 levels and cancer-related survival rate (CRS) was evaluated. Additionally, we examined whether simultaneous PROK1 expression in both primary cancer lesions and plasma was correlated with CRS. The cancer-related survival rate was calculated using the Kaplan-Meier method, and survival estimates were compared using the log-rank test. Results We have gathered eligible 130 CRC patients retrospectively. Out of 130 patients, 61 (46.9%) were positive on IHC in primary cancer, and 69 (53.1%) were negative, while 43 (33.1%) had high-value PROK1 in plasma. Out of these 43, 30 (25.4%) also had concomitant higher IHC expression in primary cancer. The plasma PROK1 levels tended to increase with advancing stages. The plasma PROK1-positive group had a lower 5-year CRS than the negative group (63.6% vs. 88.2%; P = 0.006). Additionally, simultaneous PROK1 expression was associated with a more significant decrease of 5-year CRS than both negative groups in all stages (76.2% vs. 92.5%; P = 0.003) and stage III (59.3% vs. 84.5%; P = 0.047). Multivariate analysis showed simultaneous PROK1 expression was independently associated with worse CRS (HR, 1.97; 95% CI 1.20‑3.24, P < 0.01). Conclusion PROK1 expression in preoperative plasma reflects poor prognosis in patients undergoing curative resection for colorectal cancer. The plasma PROK1 level may be a potential predictive marker, especially in stage III colorectal cancer patients.

scholarly journals Artificial Intelligence in Decision-Making for Colorectal Cancer Treatment Strategy: An Observational Study of Implementing Watson for Oncology in a 250-Case Cohort

2021 ◽  
Vol 10 ◽  
Author(s):  
Batuer Aikemu ◽  
Pei Xue ◽  
Hiju Hong ◽  
Hongtao Jia ◽  
Chenxing Wang ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Treatment Strategy ◽  
Colorectal Cancer Patient ◽  
Treatment Recommendations ◽  
Learning Ability ◽  
Cancer Center ◽  
Colorectal Cancer Patients

BackgroundPersonalized and novel evidence-based clinical treatment strategy consulting for colorectal cancer has been available through various artificial intelligence (AI) supporting systems such as Watson for Oncology (WFO) from IBM. However, the potential effects of this supporting tool in cancer care have not been thoroughly explored in real-world studies. This research aims to investigate the concordance between treatment recommendations for colorectal cancer patients made by WFO and a multidisciplinary team (MDT) at a major comprehensive gastrointestinal cancer center.MethodsIn this prospective study, both WFO and the blinded MDT’s treatment recommendations were provided concurrently for enrolled colorectal cancers of stages II to IV between March 2017 and January 2018 at Shanghai Minimally Invasive Surgery Center. Concordance was achieved if the cancer team’s decisions were listed in the “recommended” or “for consideration” classification in WFO. A review was carried out after 100 cases for all non-concordant patients to explain the inconsistency, and corresponding feedback was given to WFO’s database. The concordance of the subsequent cases was analyzed to evaluate both the performance and learning ability of WFO.ResultsOverall, 250 patients met the inclusion criteria and were recruited in the study. Eighty-one were diagnosed with colon cancer and 189 with rectal cancer. The concordances for colon cancer, rectal cancer, or overall were all 91%. The overall rates were 83, 94, and 88% in subgroups of stages II, III, and IV. When categorized by treatment strategy, concordances were 97, 93, 89, 87, and 100% for neoadjuvant, surgery, adjuvant, first line, and second line treatment groups, respectively. After analyzing the main factors causing discordance, relative updates were made in the database accordingly, which led to the concordance curve rising in most groups compared with the initial rates.ConclusionClinical recommendations made by WFO and the cancer team were highly matched for colorectal cancer. Patient age, cancer stage, and the consideration of previous therapy details had a significant influence on concordance. Addressing these perspectives will facilitate the use of the cancer decision-support systems to help oncologists achieve the promise of precision medicine.

scholarly journals Changes in the quality of care of colorectal cancer in Estonia: a population-based high-resolution study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035556
Author(s):  
Heigo Reima ◽  
Jaan Soplepmann ◽  
Anneli Elme ◽  
Mari Lõhmus ◽  
Rena Tiigi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Clinical Data ◽  
Population Based ◽  
Treatment Patterns ◽  
Stage Iii ◽  
Liver Imaging ◽  
Colon And Rectal Cancer ◽  
Incident Cases

ObjectivesLarge disparities in colorectal cancer (CRC) management and survival have been observed across Europe. Despite recent increases, the survival deficit of Estonian patients with CRC persists, particularly for rectal cancer. The aim of this study was to examine diagnostic, staging and treatment patterns of CRC in Estonia, comparing clinical data from 1997 and 2011.DesignNationwide population-based retrospective study.SettingEstonia.ParticipantsAll incident cases of colon and rectal cancer diagnosed in 1997 and 2011 identified from the Estonian Cancer Registry. Clinical data gathered from medical records.Outcome measuresDifferences in diagnostic, staging and treatment patterns; 5-year relative survival ratios.ResultsThe number of colon cancer cases was 337 in 1997 and 498 in 2011; for rectal cancer, the respective numbers were 209 and 349. From 1997 to 2011, large increases were seen in the use of colonoscopy and lung and liver imaging. Radical resection rate increased from 48% to 59%, but emergency surgeries showed a rise from 18% to 26% in colon and from 7% to 14% in rectal cancer. The proportion of radically operated patients with ≥12 lymph nodes examined pathologically increased from 2% to 58% in colon cancer and from 2% to 50% in rectal cancer. The use of neoadjuvant radiotherapy increased from 6% to 39% among stage II and from 20% to 50% among patients with stage III rectal cancer. The use of adjuvant chemotherapy in stage III colon cancer increased from 42% to 63%. The 5-year RSR increased from 50% to 58% in colon cancer and from 37% to 64% in patients with rectal cancer.ConclusionsMajor improvements were seen in the diagnostics, staging and treatment of CRC in Estonia contributing to better outcomes. Increase in emergency surgeries highlights possible shortcomings in timely diagnosis and treatment.

Colorectal cancer under the age of 50 years in U.S. Department of Veterans Affairs: Is there a role of early screening?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4072-4072
Author(s):  
Abdul Moiz Khan ◽  
Zainub Ajmal ◽  
Usman Naseer ◽  
Darren Gemoets ◽  
Syed Arzoo Mehdi
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
African Americans ◽  
Age Groups ◽  
Stage Iii ◽  
Age Group ◽  
Early Screening ◽  
Screening Guidelines ◽  
Colon And Rectal Cancer

4072 Background: While the overall incidence of colorectal cancer (CRC) is decreasing, the rate has increased in population under 50, with higher stages at diagnosis and a greater proportion of African Americans (AA). Hence, there is an ongoing debate about the age of CRC screening. These trends have not been studied in the VA population. Methods: ICD-10 codes C18-C20 were used to identify the cases of colon and rectal cancer in National VA Cancer Cube Registry. 43,544 cases of colon cancer, 1,278 below and 42,254 above age 50, and 19,815 cases of rectal cancer, 862 below and 18,948 above age 50 were identified between 2003-17. Younger age group was defined as patients less than 50 years old. IRB approval was obtained. Results: Our data comprised > 97% of male patients. In younger group, in the 5 year periods, 2003-07, 2008-12 and 2013-17, colon cancer rate increased from 2.59% to 2.79% to 3.59%, while for rectal cancer it increased from 3.5% to 4.3% to 5.3% (p < .0001). Blacks comprise 31.6% cases of colon cancer and 27.15% cases of rectal cancer in under 50 group, compared to 18.5% and 15.9% of cases in above 50 group respectively (p < .0001). For under 50 group, 48.6% cases of colon and 42.2% cases of rectal cancer were diagnosed in stage III or IV compared to 35.7% and 34.05% cases in above 50 group respectively (p < .0001). For colon cancer, 51.87% of patients in the younger group have a < 5 year survival, worse compared to 45.05% in 50-60 group (p < .0001) and similar to 49.3% in 60-70 group (p = .08). For rectal cancer, 5 year survival showed no difference between these groups. Stage specific survival shows no difference for either colon or rectal cancer across < 50, 50-60 and 60-70 age groups. Conclusions: Rate of CRC is rising in < 50 age group with more advanced stage at diagnosis and higher proportion of African Americans. For colon cancer, < 50 group has a worse 5 year survival as compared to 50-60 age group likely due to increased proportion of patients in stage III or IV, as there is no difference in stage specific survival. For rectal cancer, the 5 year survival or stage specific survival shows no difference in < 50, 50-60 and 60-70 groups. These results add to our understanding of the trends of CRC and should be accounted for in the screening guidelines.

scholarly journals Treatment and Outcomes of Colorectal Cancer in Armenia: A Real-World Experience From a Developing Country

2020 ◽  
pp. 1286-1297
Author(s):  
Samvel Bardakhchyan ◽  
Sergo Mkhitaryan ◽  
Davit Zohrabyan ◽  
Liana Safaryan ◽  
Armen Avagyan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Prognostic Factors ◽  
Cox Regression ◽  
Survival Rates ◽  
Stage Iv ◽  
Final Analysis ◽  
Stage Ii ◽  
Stage Iii ◽  
Rank Test

PURPOSE In Armenia, colorectal cancer (CRC) is one of the most frequently diagnosed cancers. It is in the third place by incidence. The aim of this study was to evaluate treatment and outcomes of CRC in Armenia during the last 9 years. MATERIALS AND METHODS For this retrospective hospital-based study, we have collected data from two main oncology centers in Armenia: National Oncology Center and “Muratsan” Hospital of Yerevan State Medical University. The information about patients with CRC who were treated at these two centers between January 1, 2010 and July 1, 2018 was collected from the medical records. Log-rank test and Kaplan-Meier curves were used for survival analysis. Prognostic factors were identified by Cox regression. RESULTS A total of 602 patients with CRC were involved in the final analysis. Median follow-up time was 37 months (range, 3-207 months). A total of 8.6% of patients had stage I, 32.9% stage II, 38.0% stage III, and 17.6% stage IV cancer; for 2.7% patients, the stage was unknown. The main independent prognostic factors for overall survival (OS) were tumor stage, grade, and histology. Adjuvant chemotherapy has been shown to improve survival in stage II colon cancer and stage III rectal but not in stage II rectal cancer. Radiotherapy did not yield survival improvement in stage II or III rectal cancer. Three- and 5-year OS rates were 62.9% and 51.8% for all stages combined and 79.7% and 68.5% for stages I-II, 62.5% and 48.4% for stage III, and 24.4% and 17% for stage IV respectively. CONCLUSION As seen from our results, our survival rates are lower than those of the developed world. Additional research is needed to identify the underlying reasons and to improve patients’ treatment and outcomes in Armenia.

Treatment of colorectal cancer in elder patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19595-19595
Author(s):  
A. Piga ◽  
M. Miscoria ◽  
G. Aprile ◽  
M. Cozzi ◽  
E. Iaiza ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Stage Iv ◽  
Stage Iii ◽  
Treatment Preference ◽  
Chi Square ◽  
Elder Patients ◽  
Therapeutic Decisions ◽  
Clinical Records

19595 Background: Tumor-related mortality is higher in elder patients worldwide. This may be due to comorbidities associated with age but also, at least in part, to a cautious approach by the attending physician(s) which might result in inadequate or even denied treatment. This approach is purportedly justified by scarcity of literature reports on effectiveness, tolerance and side effects of chemotherapy and other treatments on this category of patients. Methods: We have reviewed clinical records of patients of 70 years of age or older with colorectal cancer who came to our first observation between January 2004 and April 2006. We have correlated the appropriateness of therapeutic decisions, based on adherence to clinical standards, to the clinical characteristics of the patients and in particular to number and degree of coexisting morbidities. Chi square test was used for analysing the association between variables. Results: We have reviewed the records of 193 patients with colorectal cancer, to a total of 215 events, including 22 relapses in the same patients, in which a new therapeutic decision was involved. Adjuvant treatment was omitted in 40% of patients with stage III colon cancer, and 38% of patients with stage III rectal cancer. Chemotherapy was also omitted in 34% of patients with stage IV colon cancer and 35% of patients with stage IV rectal cancer. Even when patients received treatment, preference was given to drugs and regimens of low toxicity. Therapeutic decisions appeared in most cases based on age rather than number and severity of comorbidities. On the other hand, once the decision to treat was taken, the treatment was given as programmed, although 21% of patients received drug doses lower than 75% of projected dose; reasons for abandoning the treatment were progression and toxicity in stage IV, and more often patient's refusal in stage III. Conclusions: In a disease where standards of treatment are well defined, elder patients often receive inadequate treatment or no therapy at all. Although the justification for inadequate treatment is or should be poor clinical conditions of patients, this is not apparent from review of clinical records. Efforts should be made to have in elder patients standardised evaluation of physical status and comorbidities on a regular basis. No significant financial relationships to disclose.

Neoadjuvant treatment with chemotherapy or chemoradiation in stage III non-small cell lung cancer: Analysis of the National Cancer Database.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7046-7046
Author(s):  
Sindhu Janarthanam Malapati ◽  
Sunny R K Singh ◽  
Rohit Kumar ◽  
Tarik H. Hadid
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Tumor Resection ◽  
Postoperative Mortality ◽  
Stage Iii ◽  
Rank Test ◽  
R0 Resection ◽  
Significant Difference ◽  
Stage Iii Nsclc

7046 Background: Use of neoadjuvant chemotherapy (Neo-chemo) improves survival in locally advanced NSCLC. However, data regarding the benefit of adding radiation (Neo-CRT) is limited. Meta-analyses suggest that the use of Neo-CRT could lead to significant tumor downstaging but with increase in therapy-related mortality. Methods: Patients with resected stage III NSCLC were identified from the NCDB between 2010 and 2015. Patients were divided into two groups based on the type of neoadjuvant therapy received (Neo-chemo vs. Neo-CRT). Surgical and survival outcomes were compared. Kaplan-Meier method and log-rank test were used for survival analysis. Results: Of the 136,942 patients with stage III NSCLC, 15,804 patients had definitive surgery. Mean age was higher for those who received Neo-chemo (63.8 vs. 61.8 years, p<0.0001). Median overall survival (OS) for Neo-CRT was 49.8 months and for Neo-chemo was 53.6 months. After adjusting for treatment facility, age, gender, race, comorbidity index, insurance status, T and N stage, there was a 12% reduction in mortality with use of Neo-chemo compared to Neo-CRT (p=0.03, 95% confidence interval 0.78-0.98). 3 years OS for Neo-CRT and Neo-chemo was 51.1 and 54.3%, respectively. The 30-day operative mortality rate was slightly higher in the Neo-chemo group (4.6 vs. 3.2%, p=0.004) but 90-day mortality rates were similar (7.41% vs. 6.83%, p=0.37). Length of hospital stay for primary tumor resection was shorter for the Neo-chemo group (5 vs. 6 days, p<0.0001); however, there was no significant difference in 30-day readmission rates between the two groups (91.53% vs. 94.01%, p=0.09). Conclusions: In this study, neoadjuvant chemotherapy resulted in 12% lower mortality compared to neoadjuvant chemoradiation despite the notable increase in the rate of complete pathologic tumor and nodal response achieved with the addition of neoadjuvant radiation. There was no difference in R0 resection rates, postoperative mortality or readmissions between the two groups. [Table: see text]

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