In patients with colon cancer who have undergone surgery and treatment with adjuvant chemotherapy, early mortality may be infrequent but more prevalent in those in an advanced age as well as an Eastern Cooperative Oncology Group performance status (PS) of at least 2, according to a study published in the Journal of Clinical Oncology.1
Researchers led by Winson Cheung, MD, of the British Columbia Cancer Agency in Vancouver, Canada, examined 37 568 patients from 25 randomized trials of treatment with adjuvant systemic therapy. They used multivariable logistic regression models with several definitions of early mortality and adjusted for clinically and statistically significant variables.
With a median age of 61 years, patient demographics were found to be 29% with stage 2 disease and 71% with stage 3 disease. In terms of Eastern Cooperative Oncology Group PS, 79% were at 0, 20% were at 1, and 1% were at least 2 or more.
Early mortality was found to be low, with 0.3% at 30 days, 0.6% at 60 days, 0.8% at 90 days, and 1.4% at 6 months. Among patients who died by 6 months post-random assignment, 40% were found to have documented disease recurrence prior to death.
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Additionally, early disease recurrence was associated with a marked increase in the risk of death during the first 6 months post-treatment.
Upon prognostic analyses, advanced age, male sex, poorer PS, increasing ratio of positive to examined lymph nodes, earlier decade of enrollment, and higher tumor stage and grade were found to predict a greater likelihood of early mortality. Treatment received was not found to be strongly predictive.
- Cheung WY, Renfro LA, Kerr D, et al. Determinants of early mortality among 37,568 patients with colon cancer who participated in 25 clinical trials from the adjuvant colon cancer endpoints database [published online ahead of print February 8, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.65.1158.