The role of neoadjuvant chemotherapy in the treatment of locally advanced colon cancer in comorbid patients

Colon cancer is one of the most common cancers in the world. In most patients, a locally advanced process is detected, which requires careful selection of optimal management tactics. In this connection, neoadjuvant chemotherapy (NACHT) is being actively introduced into clinical practice. Aim of the study was to evaluate the effectiveness of NACHT in comorbid patients with locally advanced colon cancer.

Material and methods. The study was prospective and randomized, it included 254 patients with locally advanced colon cancer (cT4N0M0, cT1-4N1-2M0). Various comorbidities were detected in 96.5 % of patients. The final analysis included 53 patients from the NACHT + ACHT group and 98 patients receiving only ACHT. Statistical data processing was performed using RStudio software (version 2024.12.1+563) in the R programming language.

Results. Disease progression was significantly more frequent in patients receiving NACHT + ACHT compared to patients in the ACHT group: 35.3 and 19.6 %, respectively (p = 0.036). In addition, patients receiving NACHT + ACHT progressed faster than patients receiving ACHT only: the median time without progression was 10.0 and 12.0 months, respectively (p = 0.033). The 3-year relapse-free survival rate was lower in the NACHT + ACHT group than in patients who underwent surgery followed by ACHT at the first stage – 40 and 76 %, respectively (р = 0,000). Cox regression analysis showed that the use of NACHT at the first stage of treatment in comorbid patients with locally advanced colon cancer increases the risk of progression by 3.912 times, regardless of the stage of the disease (hazard ratio = 3.912; 95 % confidence interval 1.859–8.232; p < 0.001).

Conclusions. For comorbid patients with locally advanced colon cancer, it is most advisable to perform surgery at the first stage of treatment without prior NACHT, which is associated with a higher risk of disease progression regardless of the stage. The obtained results may be related to the increased time to surgery due to the administration of NACHT, which creates a potential temporal "window" for the maintenance of the tumor process.

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