Thématique :
- Cancer colorectal (CCR)
Originalité :
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Professeur Astrid LIÈVRE
Coup de coeur :
Journal of clinical oncology (JCO)
  2016 Apr 10;34(11):1182-9  
  doi: 10.1200/JCO.2015.65.1158  
  Determinants of Early Mortality Among 37,568 Patients With Colon Cancer Who Participated in 25 Clinical Trials From the Adjuvant Colon Cancer Endpoints Database.  
  Cheung WY, Renfro LA, Kerr D, de Gramont A, Saltz LB, Grothey A, Alberts SR, Andre T, Guthrie KA, Labianca R, Francini G, Seitz JF, O'Callaghan C, Twelves C, Van Cutsem E, Haller DG, Yothers G, Sargent DJ  


Factors associated with early mortality after surgery and treatment with adjuvant chemotherapy in colon cancer are poorly understood. We aimed to characterize the determinants of early mortality in a large cohort of colon cancer trial participants.


A pooled analysis of 37,568 patients in 25 randomized trials of adjuvant systemic therapy was conducted. Multivariable logistic regression models with several definitions of early mortality (30, 60, and 90 days, and 6 months) were constructed, adjusting for clinically and statistically significant variables. A nomogram for 6-month mortality was developed and validated.


Median age among patients was 61 years, patient demographics included 54% men and 90% White, 29% and 71% had stage II and III disease, respectively, and 79%, 20%, and 1% had an Eastern Cooperative Oncology Group performance status (PS) of 0, 1, and ≥ 2, respectively. Early mortality was low: 0.3% at 30 days, 0.6% at 60 days, 0.8% at 90 days, and 1.4% at 6 months. Of those patients who died by 6 months post-random assignment, 40% had documented disease recurrence prior to death. Early disease recurrence was associated with a markedly increased risk of death during the first 6 months post-treatment (hazard ratio, 82.6; 95%CI, 66.9 to 102.1). In prognostic analyses, advanced age, male sex, poorer PS, increasing ratio of positive to examined lymph nodes, earlier decade of enrollment, and higher tumor stage and grade predicted a greater likelihood of early mortality, whereas treatment received was not strongly predictive. A multivariable model for 6-month mortality showed strong optimism-adjusted discrimination (concordance index, 0.73) and calibration.


Early mortality was infrequent but more prevalent in patients with advanced age and a PS of ≥ 2, underscoring the need to carefully consider the risk-to-benefit ratio when making treatment decisions in these subgroups.

Question posée
Déterminer les facteurs ayant un impact sur la mortalité précoce après chimiothérapie adjuvante de cancer colique (stade II ou III).
Question posée
La mortalité précoce après chimiothérapie adjuvante est très faible (max 1,4% à 6 mois) mais augmente de manière significative chez les patients âgés et à l’état général altéré (PS≥2). La survenue d’une récidive précoce est associée à une augmentation significative du risque de décès. Le grade de différentiation tumoral, le ratio nombre de ganglions positifs/examinés et le stade T sont également des facteurs prédictifs de récidive à 6 mois.

Nécessité de prendre en compte le ratio bénéfice risque d’une chimiothérapie adjuvante chez les patients âgés et/ou avec altération de l’état général.