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SandiaBuddy's picture
SandiaBuddy
Posts: 812
Joined: Apr 2017

This interesting new article (abstract only) finds no survival advantage for chemo over no chemo for stage 3: https://www.ncbi.nlm.nih.gov/pubmed/30253025

After adjustment for the competing risk of non-colorectal cancer death, there was no significant difference in recurrence between the 204 patients who received chemotherapy and the 159 who did not (hazard ratio [HR] 0.94, CI 0.66-1.32, p = 0.700) and no significant difference in colon cancer-specific death (HR 0.73, CI 0.50-1.04, p = 0.084 - HR 0.88, CI 0.57-1.36, p = 0.577 after adjustment for relevant covariates). . . These findings question the routine use of chemotherapy after complete mesocoloic excision for stage III colon cancer. 

plsletitrain
Posts: 253
Joined: Jul 2017

Okay so this is just....groundbreaking.  I wonder how my onco will react if I tell him about this.  I was actually on the fence about getting chemo after removal of my lung met.  But since it was a confirmed lung met, its riskier if I don't get chemo.   :( 

plsletitrain
Posts: 253
Joined: Jul 2017

...the low-risk stage 3? Stage 3A perhaps? And the surgeon must have gotten a big chunk of lymph nodes.  Far enough where the cancer couldn't have gotten to.  

SandiaBuddy's picture
SandiaBuddy
Posts: 812
Joined: Apr 2017

Unfortunately, I could not get the full article.  It is more of an academic interest since I have already done the chemo, but it makes one wonder.  The gist of it to me is that in that small sample, when they adjusted for all the other variables (co-morbidites and the like), the results were similar.  Food for thought.

steveja
Posts: 41
Joined: Apr 2017

The abstract is pre-publication date.  Might be available in a few days, but paywalled.

Reading the abstract - it's interesting but not very important.  The study of 363patients, 159 had no chemo based on a jujdement of "suitability" of a multi-disciplinary team.

The "difference in recurrence between" [chemo/no-chemo] (hazard ratio [HR] 0.94, CI 0.66-1.32, p = 0.700).

p=0.70 means that this result is more likely to be random noise than not! Extremely weak statistial significance.

 

"and no significant difference in colon cancer-specific death (HR 0.73, CI 0.50-1.04, p = 0.084 - HR 0.88, CI 0.57-1.36, p = 0.577 after adjustment for relevant covariates)"

The huge confidence intervals (CI 0.50-1.04 and CI 0..57-1.36) mean there really isn't enough data to show much, and the statistical significance for the no-chemo group p=0.577 is again just noise.   The only statistically informative bit is that there is a marginally statistically supported case (p=0.084, - only about 1 on 12 odds of being chance) that the chemo group had a hazard ratio between 0.50 and 1.04 (iow bentween same odds vs half the odds).  Ho-hum.

 

My OPINION is that this probably meaninglesss and is probably going nowhere.   First, it would be unethical to assign stageIII pt randomly to chemo/no-chemo groups since there is ample prior evidence that chemo improves statistical survival.  So no proper studies can ethically be done.  It is only possible to do retrospecive data based on patients who either rejected chemo (self-selected) or who were judged as poor subjects for chemo.    *MAYBE* someone will do such a study on one of the large detailed databases in the US or Netherlands, but this study is at best a very weak hint or more probably noise (as the numbers indicate).

 

steveja
Posts: 41
Joined: Apr 2017

This is a meta-sudy covering a lot more patients ... (payall)

https://www.clinicaloncologyonline.net/article/S0936-6555(17)30118-8/abstract

"Patients with completely resected stage III colon cancer have an overall survival benefit from adjuvant chemotherapy. Combination chemotherapy (5-fluorouracil/leucovorin/oxaliplatin or capecitabine/oxaliplatin) provides a larger benefit than monotherapy but with additional toxicity."

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

The gag is that nothing "was significant", all p values were over 0.05

Betsydoglover's picture
Betsydoglover
Posts: 1254
Joined: Jul 2005

Granted I am Stage 4 and may have a different perspective, but regardless of stats, you either survive or you do not.  A not insigifant number of people survived.  A not insignifant number of people did not.  IMO doing adjuvant chemo maximizes chances of survival.  every one has to make their own choice, But I am 13+ years out from stage 4 diagnosis and 9+ years NJED since my first (and only recurrence).  My view is that you should throw everything at it that you can, and then if you can not tolerate it, dial it down or stop it. Just my 2cents.

Annabelle41415's picture
Annabelle41415
Posts: 6076
Joined: Feb 2009

I've learned to stay off the internet for information on statistics as it can be very misleading.  Always appreciate your info, but hate to rely on anything, including doctors accounts of what to expect.  The internet info can give false hope to people actually needing something different.

Kim

SandiaBuddy's picture
SandiaBuddy
Posts: 812
Joined: Apr 2017

Kim:  This article is from my regular review of pubmed, which is medical/scientific, with a few exceptions.  I posted this under "interesting" as this is water under the bridge for me, but I do think there is a lot of room for alternative approaches.  Chemo has cost me and many others on this board a lot.  From my perspective, it does not hurt to ask the question if it is really worth it.

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