To the Editor We read with interest the article by Manjelievskaia et al.1 While pertinent questions are raised, we strongly question their conclusion statements.
It is plausible that the lack of benefit of postoperative chemotherapy in young patients with stage II and III colorectal cancer seen in this study could be related to methodology and analytical flaws. Limiting factors of this study that may severely cripple its conclusions are its retrospective nature, its somewhat specific patient population that limits extrapolation to broader groups of Americans as well as sites of cancer-care delivery, the lack of cancer-specific mortality evaluation (authors use all-cause mortality), the absence of data regarding dose density and dose intensity of chemotherapy delivered, the absence of data in reference to timing of initiation of postoperative chemotherapy, the lack of molecular data that could potentially skew results (eg, microsatellite instability), its limited information about the quality of oncologic surgery for initial treatment, and the lack of data in reference to survivorship follow-up, ie, adherence to standard guidelines of care.
Gordan LN, Diaz M. Use of Adjuvant Chemotherapy After Surgery in Patients With Colon Cancer. JAMA Surg. 2017;152(9):894–895. doi:10.1001/jamasurg.2017.1616
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