The Slow Adoption of Neoadjuvant Treatment for Clinical T4b Colon Cancer: A National Cancer Database Analysis
1Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Francisco, California, USA.
Background:
Emerging data support the use of neoadjuvant treatment (NAT), particularly immunotherapy in microsatellite instability-high (MSI-H) tumors. We evaluate national trends in NAT utilization for clinical T4b colon cancers and its association with overall survival, with a focus on MSI-H tumors.
Methods:
We conducted a retrospective cohort study using the National Cancer Database (2010-2022) evaluating patients with non-metastatic clinical T4b colonic adenocarcinoma who underwent colectomy. The primary outcome measures were trends in NAT utilization and overall survival.
Results:
Among 8862 patients with clinical T4b colon cancer, NAT utilization increased over time, peaking at 28% in the most recent quartile. NAT recipients were more likely younger, healthier, and to be treated at academic centers. NAT was associated with higher R0 resection rates (83% vs 77%, p < 0.001) and significantly longer mean overall survival (105 vs 80 months, p < 0.001). Among MSI-H patients (11% of the cohort), 15% received NAT. Immunotherapy use increased steadily, surpassing chemotherapy in 2022. Patients receiving neoadjuvant immunotherapy +/- chemotherapy demonstrated superior survival to chemotherapy alone (106 vs 85 months, p < 0.001).
Conclusions:
Neoadjuvant therapy use has increased nationally, with a notable rise in immunotherapy for MSI-H tumors. Neoadjuvant treatment, particularly immunotherapy, is associated with significant overall survival benefit.
Insights
Neoadjuvant therapy (NAT) use is rising for T4b colon cancers, especially immunotherapy for microsatellite instability-high (MSI-H) tumors. NAT, particularly immunotherapy, significantly improves survival rates in these patients.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Research
Background:
- Neoadjuvant treatment (NAT) is increasingly recognized for its potential in managing colon cancers, particularly in microsatellite instability-high (MSI-H) subtypes.
- The role of NAT, especially immunotherapy, in advanced T4b colon cancers warrants detailed investigation into national utilization trends and survival outcomes.
Purpose of the Study:
- To evaluate national trends in neoadjuvant therapy utilization for clinical T4b colon cancers.
- To assess the association between NAT and overall survival in patients with T4b colon cancer, with a specific focus on MSI-H tumors.
Main Methods:
- Retrospective cohort study utilizing the National Cancer Database (2010-2022).
- Inclusion criteria: patients with non-metastatic clinical T4b colon adenocarcinoma who underwent colectomy.
- Primary outcomes: trends in NAT utilization and overall survival.
Main Results:
- NAT utilization increased to 28% in the most recent quartile among 8862 patients.
- NAT was linked to higher R0 resection rates (83% vs 77%) and improved overall survival (105 vs 80 months).
- Among MSI-H patients, neoadjuvant immunotherapy +/- chemotherapy showed superior survival compared to chemotherapy alone (106 vs 85 months).
Conclusions:
- National neoadjuvant therapy use, including immunotherapy for MSI-H tumors, is increasing.
- Neoadjuvant treatment, particularly immunotherapy, offers a significant overall survival benefit for patients with T4b colon cancer.
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