EP633 - Factors associated with refusal of surgery in Stage I-III colon adenocarcinoma and their effect on survival.

Monday, May 12, 2025

8:10 AM – 8:15 AM PT

Location: Monitor 5, Sails Pavilion, Upper Level

ePoster Presenter(s)

Carter H. Quinn, n/a

Medical Student
Medical College of Georgia
Marietta, Georgia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

MM

Malek Moumne, n/a

Medical Student
Medical College of Georgia
Augusta, Georgia, United States

Disclosure information not submitted.
RQ

Ryan Quisling, n/a

Medical Student
Medical College of Georgia
Augusta, Georgia, United States

Disclosure information not submitted.
LS

Lauren Springsteen, n/a

Medical Student
Medical College of Georgia
Augusta, Georgia, United States

Disclosure information not submitted.
PJ

Palmer Jonathan, n/a

Medical Student
Medical College of Georgia
Augusta, Georgia, United States

Disclosure information not submitted.
SS

Sohawm Sengupta, n/a

Medical Student
Medical College of Georgia
Augusta, Georgia, United States

Disclosure information not submitted.
LG

Luke Guy, n/a

Medical Student
Medical College of Georgia
augusta, Georgia, United States

Disclosure information not submitted.
GC

Gustavo Capo, n/a

Medical Student
Medical College of Georgia
Augusta, Georgia, United States

Disclosure information not submitted.
YP

Yagni Patel, n/a

Medical Student
Medical College of Georgia
Augusta, Georgia, United States

Disclosure information not submitted.
Swadha Guru, MD

Assistant Professor
Medical College of Georgia
Henry Ford Hospital
Augusta, Georgia, United States

Disclosure information not submitted.

Senior Author(s)

DY

Danny Yakoub, MD, PHD

Chief of Division of Surgical Oncology
Medical College of Georgia at Augusta University - Georgia Cancer Center
Augusta, Georgia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Carter H. Quinn, n/a: This individual has no financial relationships with ineligible companies.

Danny Yakoub, MD, PHD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Surgical resection is a key component in the treatment of stage I-III colonic adenocarcinomas (CAC). Yet, some patients refuse surgery. We examined the factors associated with surgery refusal and its effect on overall survival (OS).

Methods/Interventions: The National Cancer Database (2004-2019) was queried for patients with stage I-III CAC who were recommended surgery. Patients who underwent surgery were compared to those who refused it. Logistic regression was used to identify variables associated with surgery refusal. Propensity scored matching (PSM) was implemented to produce comparable groups in terms of demographics, disease characteristics, and treatment. Kaplan-Meier and Log-Rank analysis were used to determine the effect of surgery refusal on OS. A Cox-Proportional Hazard Model was implemented to investigate factors influencing OS.

Results/Outcomes: A total of 702,747 patients with stage I-III CAC were recommended to undergo surgery, of which 1,475 (0.2%) patients refused. On logistic regression, age>50 years, female sex, non-Hispanic Black race and Charleson Deyo comorbidity score (CDCS) of 2+, tumor size>2 cm, refusal of chemotherapy, and multiple sites of tumor were associated with higher odds or surgery refusal. On the other hand, socioeconomic factors such as median income >$50,000 and private insurance holders were associated with decreased odds of surgery refusal. Kaplan-Meier and Log-Rank analysis of PSM groups showed a lower median survival in patients who refused surgery across all stages in comparison to those who underwent surgical resection: Stage-1 [14.53 vs 87.98 mos. HR=4.07, P< 0.01], Stage-2 [8.76 vs 65.45 mos. HR=3.28, P< 0.01], and Stage-3 [10.44 vs 32.64 mos. HR=1.95, P< 0.01] (Figure 1). Among patients who declined surgery, the multivariate Cox model showed that age >50, female sex, CDCS 1+, tumor size 4+ cm, clinical stage 2+, refusal of chemotherapy, and treatment facility in the Midwest and West were associated with decreased survival while non-Hispanic black race, Hispanic white race and distal primary tumor location were associated with increased survival (P < 0.05).

Conclusion/Discussion: Refusal of surgery is associated with decreased survival across all stages of CAC. Targeted counseling and interventions can help mitigate the identified factors associated with surgery refusal to improve outcomes.