Factors Associated With Early Mortality in Patients Receiving Adjuvant Therapy for Colon Cancer
In an analysis of the ACCENT (Adjuvant Colon Cancer Endpoints) database reported in the Journal of Clinical Oncology, Cheung et al found that factors associated with early mortality in patients in trials of adjuvant systemic therapy included age, performance status, tumor grade, stage, and ratio of positive lymph nodes to nodes examined.
Study Details
The study was a pooled analysis of 37,568 patients from 25 randomized trials of adjuvant systemic therapy. Early mortality was 0.3% at 30 days, 0.6% at 60 days, 0.8% at 90 days, and 1.4% at 6 months. Among patients dying within 6 months of randomization, 40% had disease recurrence prior to death (hazard ratio = 82.6, 95% confidence interval = 66.9–102.1).
Prognostic Factors
In multivariate analyses excluding disease recurrence, increasing age (P < .001), worse Eastern Cooperative Oncology Group performance status (P < .001), and higher tumor grade (P = .009) were significantly associated with an increased risk of 30-day mortality. Significant factors for mortality at 60 and 90 days were increased age (P < .001 for both), worse performance status (P < .001 for both), higher tumor grade (P = .004 at 60 days, P < .001 at 90 days), and increased ratio of positive lymph nodes to nodes examined (P = .010 at 60 days, P < .001 at 90 days). Significant factors for mortality at 6 months were increased age (P < .001), worse performance status (P = .002), higher tumor grade (P < .001), increased ratio of positive lymph nodes to nodes examined (P < .001), higher T stage (P = .005), and earlier decade of trial enrollment (P = .005).
Odds ratios for mortality for performance status ≥ 2 vs 0 were 4.32, 4.11, 3.18, and 2.07 at 30, 60, and 90 days and 6 months, respectively. Odds ratios for patients aged 70 and 80 years vs 60 years were 2.58 and 8.61, 2.52 and 7.58, 2.46 and 7.17, and 1.87 and 4.05 at 30, 60, and 90 days and 6 months, respectively. Treatment group was not a significant factor at any time point.
The investigators concluded: “Early mortality was infrequent but more prevalent in patients with advanced age and a [performance status] of ≥ 2, underscoring the need to carefully consider the risk-to-benefit ratio when making treatment decisions in these subgroups.”
The study was supported by the National Cancer Institute.
Winson Y. Cheung, MD, of the British Columbia Cancer Agency, Vancouver, Canada, is the corresponding author of the Journal of Clinical Oncology article.
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