Effect of Adjuvant chemotherapy on early stage colon cancer in Mukdahan hospital.
Keywords:
colon cancer, chemotherapy, chemotherapy side effects, cancer recurrenceAbstract
Objective: To determine the median recurrence among stage 2 and 3 colorectal cancer patients who underwent adjuvant chemotherapy in Mukdahan Hospital.
Methodology: This was a retrospective study conducted on colorectal cancer patients at stages 2 and 3 admitted to Mukdahan Hospital from the years 2015 – 2021.
Results: A total of 185 patients were enrolled in the study and their mean age was 62.10 years. In the adjuvant chemotherapy, 51.35% of the patients received 5FU/LV regimen and 41.08% of patients had a FOLFOX regimen. The total recurrence rate was 25.95% (48 cases). The recurrence rate in 2nd and 3rd stage colorectal cancer patients was 16% (12 of 75 cases) and 37.23% (36 of 110) respectively. The 5-year recurrence-free survival rate calculated in the stage 2 patients was 74% and that of stage 3 was 56%.
Multivariate analysis revealed that the spreading of the tumor to regional lymph nodes (pathological stage N2) was 2.79 times more likely to favor recurrence than without spread to the lymph nodes (p-value = 0.03). Likewise, when the number of lymph nodes sampling was < 12, the hazard ratio of cancer recurrence was 5.16 times greater (p-value= 0.01) compared to the ≥12 number of lymph nodes sampling. Dose delay was 2.38 times more likely to favor the reappearance of colorectal cancer in the patients (p-value= 0.03).
Among the side effects of adjuvant chemotherapy, anemia was revealed in 69.89%, thrombocytopenia in 22.73%, neutropenia in 18.75%, fatigue in 5.69%, diarrhea in 3.41%, and other mild symptoms including hand-foot syndrome, oral ulcers, nausea or vomiting. Numbness of hands or feet and hepatitis. Neutropenia and thrombocytopenia were the main reasons for the dose delay.
Conclusion: The study revealed that the patients with stage 2 and stage 3 colorectal cancer after undergoing surgery and adjuvant chemotherapy had a 5-year recurrence-free survival rate of 74% and 56%. The most common side effects of the therapy including neutropenia and thrombocytopenia caused the dose delay which was associated with the recurrence of cancer in the study. With at least one risk factor, adjuvant chemptherapy is recommended in stage 2 colon cancer patients whereas chemotherapy is suggested in stage 3 colon cancer patients to prevent a recurrence after surgery.
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