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http://dx.doi.org/10.7314/APJCP.2015.16.6.2237

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 (Clinical Oncology Unit, Faculty of Medicine, National University of Malaysia)
Naicker, Manimalar (Department of Pathology, Faculty of Medicine, National University of Malaysia)
Yusof, Khairul Hazdi (Department of Community Health, Faculty of Medicine, National University of Malaysia)
Ishak, Wan Zamaniah Wan (Clinical Oncology Unit, Faculty of Medicine, National University of Malaysia)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.16, no.6, 2015 , pp. 2237-2243 More about this Journal
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.
Keywords
Colon cancer; Dukes B; Dukes C; adjuvant chemotherapy;
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