Comparative analysis of various prognostic nodal factors, adjuvant chemotherapy and survival among stage III colon cancer patients over 65 years: An analysis using Surveillance, Epidemiology and End Results (SEER)-Medicare data

N. N. Hanna, E. Onukwugha, M. A. Choti, A. J. Davidoff, I. H. Zuckerman, V. D. Hsu, C. D. Mullins

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13 Scopus citations


Aim The prognostic effects of chemotherapy and various lymph node measures [positive nodes, total node count and the positive lymph node ratio (PLNR)] have been established. It is unknown whether the cancer-specific survival benefit of chemotherapy differs across these nodal prognostic categories. Method This retrospective analysis of linked Surveillance, Epidemiology and End Results (SEER) data and Medicare data (SEER-Medicare)included patients ≥ 65years of age with a diagnosis of stage III colon cancer between 1997 and 2002. We grouped patients according to the number of positive nodes (N1 and N2), total node count (≥12 and <12 total nodes) and PLNR (below the 75th percentile and at least at the 75th percentile of the PLNR). The end point was colon cancer-specific mortality. Results Fifty-one per cent (3701) of the 7263 patients received adjuvant therapy during the time period 1997-2002. The mean (standard deviation) number of total nodes examined was 13 (9) and the number of positive nodes identified was 3 (3). Patients with N2 disease, <12 total nodes examined and a high PLNR had a worse survival at 2, 3 and 5years following colectomy. Utilization of chemotherapy demonstrated a colon cancer-specific survival benefit (hazard ratio at median follow up=0.7; P<0.001) that was consistent and statistically significant across the three nodal prognostic categories examined. Conclusion The benefit of chemotherapy did not vary based on N stage, total node count or PLNR. The results favour a broad-based approach towards increasing the chemotherapy treatment rates in stage III patients of ≥ 65years of age, rather than an approach that targets clinical subgroups.

Original languageEnglish (US)
Pages (from-to)48-55
Number of pages8
JournalColorectal Disease
Issue number1
StatePublished - Jan 1 2012



  • Chemotherapy
  • Colon cancer
  • Node ratio
  • Positive nodes
  • Survival

ASJC Scopus subject areas

  • Gastroenterology

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