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ADDED VALUE OF ADJUVANT CHEMOTHERAPY IN T1-2 NODE-POSITIVE COLON CANCER PATIENTS

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Introduction

According to the current guidelines, all patients with lymph node metastases after curative surgery for colon cancer (CC) are recommended to undergo adjuvant chemotherapy, regardless of the T-stage. However, a limited number of patients with pT1-2 CC were included in the trials that demonstrated a benefit of adjuvant chemotherapy for lymph node positive CC patients. The aim of this study was to evaluate the value of adjuvant chemotherapy in patients with lymph node-positive pT1-2 CC.

Aims & Methods

A multicenter retrospective cohort study was conducted, including patients who underwent curative surgery for T1 or T2 CC between 2014 and 2015. Patients were originally identified through the Dutch ColoRectal Audit (DCRA), a prospective national registry of all patients undergoing surgery for primary colorectal cancer. Long-term oncological follow-up data from the original patient records were added to the DCRA data by surgical residents affiliated with the Dutch Snapshot Research Group (DSRG) from 61 participating hospitals. Patients were stratified by age (< 75 or ≥75 years). Survival outcomes were compared with the Kaplan-Meier method and log-rank test. Cox proportional hazard models were used to determine risk factors associated with 5-year metastasis-free and overall survival (MFS/OS).

Results

Among the 2277 surgically treated pT1-2 CC patients, 370 (16.2%) were found to have lymph node metastases, with 262 (70.8%) of them receiving adjuvant chemotherapy (CT+). Patients who did not receive adjuvant chemotherapy (CT-) were significantly older, had a higher ASA score, and experienced more frequently a complicated postoperative course, compared to the CT+ group. Among the total cohort, the vast majority of patients (78.6%) received oxaliplatin-based chemotherapy (CAPOX) and 13% capecitabine monotherapy. Among those under < 75 years old (n = 272), CAPOX was administered in 86.3% of cases, whereas in patients ≥ 75 (n = 97), capecitabine monotherapy was given in 42.9% and CAPOX in 38.1%. In younger patients (< 75), chemotherapy significantly improved OS (68.2% CT-group versus 91.8% in CT+ group, multivariate HR 0.3, 95% CI 0.1 ─ 0.6) and also had a favorable effect on MFS (83.7% in CT-group versus 91.6% in CT+ group, multivariate HR 0.5, 95% CI 0.2 ─ 1.09). In elderly patients (≥75 years old), the administration of adjuvant chemotherapy did not significantly affect the development of distant metastases (MFS of 81.7% in the CT- group versus 84.5% in the CT+ group, log rank p value 0.73, adjusted HR 1.2, 95% CI 0.4 – 3.8)), nor survival after correction for confounders (OS of 52.7% in the CT-group versus 77% in the CT+ group, age adjusted HR 0.6, 95% CI 0.2 ─ 1.5). The choice of chemotherapy regimen (CAPOX or capecitabine monotherapy) had no influence on MFS (HR 0.6, 95% CI 0.1 ─ 3.5) or OS (0.6, 95% CI 0.1 – 2.7).

	Age < 75 No CTx n = 53	Age < 75 CTx n = 219	p value	Age ≥ 75 No CTx n = 55	Age ≥ 75 CTx n = 42	p value
Follow-up (months), median [IQR]	53 [28-61]	64 [60-70]	<.001	49 [28-63]	59 [44-63]	0.11

Recurrent disease, n (%)	8 (15.1)	19 (8.7)	0.16	11 (20)	6 (14.3)	0.46
Loco regional recurrence only	1 (1.9)	2 (0.9)		3 (5.5)	0
Distant metastases only	6 (11.3)	13 (5.9)		7 (12.7)	5 (11.9)
Loco regional recurrence + distant metastases	1 (1.9)	4 (1.8)		1 (1.8)	1 (2.4)

Unadjusted 5-Year Overall Survival (%)	68.2	91.8	<.001	52.7	77	0.02
Unadjusted 5-Year Metastasis Free Survival (%)	83.7	91.6	0.07	81.7	84.5	0.73

Conclusion

In the largest cohort of node-positive pT1-2 colon cancer patients currently available, no significant benefit of adjuvant chemotherapy in patients over 75 years of age could be demonstrated, irrespective of the regimen that is chosen.

ADDED VALUE OF ADJUVANT CHEMOTHERAPY IN T1-2 NODE-POSITIVE COLON CANCER PATIENTS

Julia Hanevelt 1, Jan Willem De Groot 1, Eva Rademaker 1, Bobby Zamaray 1, Richard M. Brohet 1, Esther C.J. Consten 2, Pieter J. Tanis 3, Leon M.G. Moons 4, Frank P. Vleggaar 4, Erik Van Westreenen 1, Wouter De Vos Tot Nederveen Cappel 1

1 Isala, Zwolle, Netherlands

2 Meander Medisch Centrum, Amersfoort, Netherlands|||University Medical Center Groningen (UMCG), Groningen, Netherlands

3 Erasmus MC, Rotterdam, Netherlands

4 University Medical Center Utrecht, Utrecht, Netherlands

Event

UEG Week Vienna 2024

Topics

Colorectal Digestive Oncology

Submission format

Abstract

Session

Local treatment for locally advanced colon cancer: How to improve outcome

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Presentation

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A case of locally advanced rectal cancer

Rodrigo Perez 1

1 University of Sao Paulo School of Medicine, Sao Paulo, Brazil

Event

UEG Postgraduate Teaching Programme 2023

Topics

Digestive Oncology

Session

Advanced colorectal cancer

Published

2023

UEG Presentation

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Q&A A case of locally advanced rectal cancer

Roel Hompes 1, Rodrigo Perez 2

1 Amsterdam UMC, Amsterdam, Netherlands

2 University of Sao Paulo School of Medicine, Sao Paulo, Brazil

Event

UEG Postgraduate Teaching Programme 2023

Topics

Digestive Oncology

Session

Advanced colorectal cancer

Published

2023

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Metastasised colorectal cancer (Complete Session)

Evelien Dekker 1, Andrea Laghi 2, Thomas Seufferlein 3

1 AMC, Amsterdam, Netherlands

2 Sapienza - University of Rome, Rome, Italy

3 Universitätsklinikum Ulm - Klinik für Innere Medizin I, Ulm, Germany

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology Endoscopy Surgery

Session

Metastasised colorectal cancer

Published

2023

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Case-based discussion of clinical subtypes AIP Type 1-3

Kasper Overbeek 1

1 Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands

Event

UEG Postgraduate Teaching Programme 2023

Topics

Immunology Pancreas

Session

Autoimmune pancreatitis: The story continues

Published

2023

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The difficult option to proceed with liver transplantation in a young female with severe autoimmune hepatitis

Isabel Conde 1

1 Consorcio Hospital General Valencia (Spain), Valencia, Spain

Event

UEG Postgraduate Teaching Programme 2023

Topics

Hepatobiliary

Session

Fulminant hepatitis, liver failure and liver transplantation

Published

2023

UEG Presentation

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STRONG WORK-LIFE-CONFLICT AMONG GASTROENTEROLOGISTS

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Introduction

Work-life integration is a critical issue many individuals face in the workforce, particularly in professions with high demands, such as healthcare. Physicians, in particular, experience significant challenges in managing their professional and personal lives due to long work hours, unpredictable schedules, and the emotional toll of caring for patients. The resulting work-life conflicts can negatively impact their well-being, job satisfaction, and patient care. Despite recognizing this issue, there is still a lack of research on the extent of work-life conflicts and their effects on physicians.

Aims & Methods

We distributed a voluntary and anonymous survey via e-mail to all members of the German Society for Digestive and Metabolic Diseases (DGVS - Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen). Sociodemographics and data on parental status, number of children, and used support structures were gathered. The Work-Family Conflict Scale (ISSP) was used to measure the compatibility of family and job. Query logic branched depending on responses, and single and multiple-choice questions were used, as well as Likert scales.

Results

At the point of this interim analysis, 586 respondents finished the survey and were included for statistical analysis. Of the respondents, 45% were women, 71% were parents, and 60.3% had children living in the household. The mean age was 47 years (SD 11,0). In most cases, respondents lived with a working partner (93%), with male respondents more likely to have a stay-at-home partner (8,9% versus 2,9%). A corresponding trend was observed in partners working part-time (Overall: 41.5%. Partners of male physicians 58,9%, partners of female physicians 17,2%). In the ISSP, there were high levels of work-life conflict (scale 1-4, average work/life 3,06 life/work 1,79). Female respondents reported statistically significantly higher work/life, but only numerically higher life/work conflicts than male respondents. (work/life 3,18 versus 2,94, p ˂ 0.001; life/work 1,88 versus 1,77 p = 0.080; two tailed Chi Square). Parents were affected significantly more often by work-life and life-work conflicts.

Conclusion

This study provides valuable insights into the challenges faced by physicians in balancing their professional and personal lives. Finding ways to manage work-life conflicts and maintain a healthy balance is critical for the well-being and longevity of physicians, as well as the quality of care they provide to their patients. Healthcare employers should support their employees in achieving a satisfactory work-life balance.

STRONG WORK-LIFE-CONFLICT AMONG GASTROENTEROLOGISTS

Sophie Schlosser-Hupf 1, Yvonne Huber 2, Karim Hamesch 3, Oscar Cahyadi 4, Enrik Geissler 5, Jonas J. Staudacher 6

1 Universitätsklinikum Regensburg, Egglfing (Köfering), Germany

2 Johannes Gutenberg University Mainz, Mainz, Germany

3 University Hospital RWTH Aachen, Aachen, Germany

4 Hospital of the Ruhr-University Bochum, Bochum, Germany

5 Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany

6 Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany|||Berlin Institute of Health at Charité Universitätsmedizin Berlin, Berlin, Germany

Event

UEG Week Copenhagen 2023

Topics

Education & Training Endoscopy

Submission format

Abstract

Session

Training and life of a young gastroenterologist

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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