Impact of age on efficacy of postoperative oxaliplatin-based chemotherapy in patients with rectal cancer after neoadjuvant chemoradiotherapy
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Xuan-zhang Huang1,2,*, Peng Gao2,*, Yong-xi Song2, Jing-xu Sun2, Xiao-wan Chen2, Jun-hua Zhao2, Bin Ma2, Jun Wang2, Zhen-ning Wang2
1Department of Chemotherapy and Radiotherapy, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Lucheng District, Wenzhou City 325027, P.R. China
2Department of Surgical Oncology and General Surgery, the First Hospital of China Medical University, Heping District, Shenyang City 110001, P.R. China
*These authors have contributed equally to this work
Zhen-ning Wang, e-mail: [email protected]
Keywords: rectal cancer, adjuvant chemotherapy, age, elderly, SEER program
Received: September 25, 2015 Accepted: January 31, 2016 Published: February 21, 2016
Background: Clinical practice guidelines focusing on age-related adjuvant chemotherapy for rectal cancer are currently limited. The present study aimed to explore the impact of age on the efficacy of adjuvant oxaliplatin-based chemotherapy in patients with rectal cancer after neoadjuvant chemoradiotherapy.
Methods: We performed a retrospective cohort analysis using data from the Surveillance, Epidemiology, and End Results-Medicare-linked database from 1992–2009. We enrolled patients with yp stages I–III rectal cancer who received neoadjuvant chemoradiotherapy and underwent curative resection. The age-related survival benefit of adding oxaliplatin to adjuvant 5-fluorouracil (5-FU) chemotherapy was evaluated using Kaplan–Meier survival analysis with propensity score-matching and Cox proportional hazards models.
Results: Comparing the oxaliplatin group with the 5-FU group, there were significant interactions between age and chemotherapy efficacy in terms of overall survival (OS) (p for interaction = 0.017) among patients with positive lymph nodes (ypN+). Adding oxaliplatin to 5-FU could prolong survival in patients aged < 73 years and ypN+ category, and but did not translate into survival benefits in patients aged ≥ 73 years and ypN+ category. No significant interactions were observed among ypN− patients, and oxaliplatin did not significantly improve OS, regardless of age.
Conclusions: In patients with rectal cancer who have already received neoadjuvant chemoradiotherapy and undergone curative resection, adding oxaliplatin to 5-FU could prolong OS in patients aged < 73 years and ypN+ category. However, adding oxaliplatin did not translate into survival benefits in patients age ≥ 73 years and ypN+ category, or in ypN− patients.
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