Neoadjuvant therapy for patients with advanced colon cancer: Analysis of the National Cancer Database (NCDB)

Background: Few real-world studies have characterized the utilization pattern and overall survival (OS) benefits associated with neoadjuvant therapy (NAT) among patients diagnosed with colon cancer. Patients and methods: In this retrospective cohort study, we identified adult patients diagnosed with stages II-IV colon cancer from 2015 to 2020 using the US National Cancer Database. Patients were grouped based on treatment modality and sequence: NAT and those treated by upfront surgery followed by adjuvant therapy (ADT). We examined utilization pattern of NAT by patients’ sociodemographic, medical, and facility characteristics. We then used Kaplan Meier method and Cox proportional hazards models to compare OS across cancer stages between two groups. Results: Of the 116,905 patients who met inclusion criteria, 8110 (6.9 ​%) received NAT. Overall, patients underwent NAT were generally younger (age ≤64 years), privately insured, diagnosed with stage IV colon cancer, and with liver metastasis. Receipt of NAT was associated with significantly improved OS among patients with stage IV colon cancer after adjusting for covariates (hazard ratio, 0.79; 95 ​% CI: 0.76–0.83, p ​< ​0.001). Subgroup analysis results showed that NAT was associated with better OS compared to those received ADT regardless of age, liver metastasis status, comorbidity score, and KRAS mutation status. For patients with stages II or III colon cancer, NAT was not associated with improved OS. Conclusion: Neoadjuvant therapy was significantly associated with improved OS among patients with stage IV colon cancer. Future investigations are needed to understand the role of NAT in locally advanced colon cancer.