J Cancer 2020; 11(14):4157-4165. doi:10.7150/jca.42404

Research Paper

Outcomes of Adjuvant Oral versus Intravenous Fluoropyrimidines for High-Risk Stage II or Stage III Colon Adenocarcinoma: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study

Jiaqiang Zhang1*, Yu-Chun Yen2*, Lei Qin3, Chia-Lun Chang4, Kevin Sheng-Po Yuan5, Alexander T.H. Wu6, Szu-Yuan Wu7,8,9,10,11✉

1. Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
2. Biostatistics Center and School of Public Health, Taipei Medical University, Taiwan.
3. School of Statistics, University of International Business and Economics, Beijing, China.
4. Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
5. Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
6. Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei, Taiwan.
7. Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
8. Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
9. Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
10. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
11. School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
*These authors have contributed equally to this study (joint primary authors).

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Citation:
Zhang J, Yen YC, Qin L, Chang CL, Yuan KSP, Wu ATH, Wu SY. Outcomes of Adjuvant Oral versus Intravenous Fluoropyrimidines for High-Risk Stage II or Stage III Colon Adenocarcinoma: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. J Cancer 2020; 11(14):4157-4165. doi:10.7150/jca.42404. Available from http://www.jcancer.org/v11p4157.htm

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Abstract

Objective: We conducted this propensity score (PS)-matched, nationwide, population-based cohort study to estimate the effects of adjuvant oral or intravenous (IV) fluoropyrimidine in patients with high-risk stage II or III colon adenocarcinoma.

Design: Using PS matching, we minimized the confounding effects on adjuvant oral or IV fluoropyrimidine outcomes in patients with high-risk stage II or III resectable colon adenocarcinoma.

Setting: We selected patients from the Taiwan Cancer Registry database receiving adjuvant fluoropyrimidine monotherapy and divided them into those receiving IV fluoropyrimidine (IV group) and those receiving oral fluoropyrimidine (oral group).

Results: In both univariate and multivariate Cox regression analyses, the adjusted hazard ratio (aHR) derived for the oral group was 1.34 (95% CI: 1.19-1.51) compared with the IV group. Moreover, in both univariate and multivariate analyses, aHR derived for significant independent prognostic risk factors for poor overall survival were male sex, age ≥ 60 years old, pathologic stage III, right-sided colon cancer, low income, and high Charlson comorbidity index. However, intergroup differences were not significant among female patients or patients < 60 years old on multivariate analysis, including no difference in overall survival.

Conclusions: Adjuvant IV fluoropyrimidine is more suitable than adjuvant oral fluoropyrimidine for patients with stage II colon adenocarcinoma who have high-risk pathologic features or stage III colon adenocarcinoma.

Keywords: Colon adenocarcinoma, mortality, fluoropyrimidine, oral, intravenous.