Neoadjuvant Versus Adjuvant Chemotherapy for Resectable Metastatic Colon Cancer in Non-academic and Academic...

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Colon cancer with synchronous liver or lung metastases presents a complex treatment scenario.
• The optimal timing of chemotherapy (before or after metastasectomy) remains unclear for these patients.

Purpose of the Study:

• To compare the overall survival (OS) of patients with colon cancer and single-organ metastatic disease (liver or lung) who received neoadjuvant chemotherapy (NAC) versus adjuvant chemotherapy (AC).
• To identify factors associated with survival outcomes in patients undergoing different chemotherapy timings.

Main Methods:

• A retrospective analysis of 3038 adult patients diagnosed with primary colon cancer and single-organ liver or lung metastases between 2010 and 2015 from the National Cancer Database (NCDB).
• Patients were stratified into two cohorts: those receiving NAC and those receiving AC.
• Multivariate analysis was employed to compare survival and identify prognostic factors.

Main Results:

• Neoadjuvant chemotherapy (NAC) showed a significant overall survival advantage (median OS 47.24 months) compared to adjuvant chemotherapy (AC) (median OS 38.08 months).
• This survival benefit was most pronounced in the non-academic healthcare setting.
• Factors associated with improved OS in the NAC group included younger age (20-49 years), elevated CEA levels (>30), right-sided primary tumors, liver metastasis, and clear resection margins.

Conclusions:

• Neoadjuvant chemotherapy is beneficial for patients with metastatic colon cancer involving single-organ liver or lung lesions, especially in non-academic settings.
• This study provides evidence for the survival advantage of neoadjuvant chemotherapy in this specific patient population, which was not previously established.