Factors Associated with the Lack of Adjuvant Chemotherapy Following Curative Surgery for Stage II and III Colon Cancer: A Korean National Cohort Study.
To evaluate factors associated with the lack of adjuvant chemotherapy after curative surgery in patients with stage II and III colon cancer based on national population-based data.



A total of 8,412 patients diagnosed with stage II or III disease who underwent curative resection were included.



Adjuvant chemotherapy was not administered in 3,057 cases (36.34%). Factors associated with the lack of chemotherapy were older age [hazard ratio (HR)=1.50 in patients 65-74 years and 5.23 in patients ≥75 years of age], female sex (HR=1.15), tumor-node-metastasis (TNM) stage II (HR=4.28), emergency surgery (HR=1.45), American Society of Anesthesiologists (ASA) score of 3 or higher (HR=1.62), fewer than 12 lymph nodes examined (HR=1.19), a greater quantity of transfusion (HR=1.08), and hospital type (tertiary referral center) (HR=1.62).



Patient-related (older age, female sex, and ASA score of 3 or higher) and treatment-related factors (TNM stage II, emergency surgery, fewer than 12 lymph nodes examined, a greater quantity of transfusion, and hospital type) influenced the lack of adjuvant chemotherapy. Given that the use of adjuvant chemotherapy improves overall survival, physicians should make an effort to increase the proportion of patients receiving chemotherapy after surgery.
Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Gye Sung
GS
Ha
Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea youngwkim@yonsei.ac.kr.
Young Wan
YW
Kim
Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Eun Hee
EH
Choi
Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Ik Yong
IY
Kim
D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D044466:Asian People; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000208:ethnology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012737:Sex Factors; D016019:Survival Analysis
Colonic neoplasms; adjuvant chemotherapy; mortality; survival