Adjuvant Chemotherapy for Stage II Colon Cancer With Poor Prognostic Features

Abstract

Purpose Adjuvant chemotherapy is typically considered for patients with stage II colon cancer characterized by poor prognostic features, including obstruction, perforation, emergent admission, T4 stage, resection of fewer than 12 lymph nodes, and poor histology. Despite frequent use, the survival advantage conferred on patients with stage II disease by chemotherapy is yet unproven. We sought to determine the overall survival benefit of chemotherapy among patients with stage II colon cancer having poor prognostic features. Patients and Methods A total of 43,032 Medicare beneficiaries who underwent colectomy for stage II and III primary colon adenocarcinoma diagnosed from 1992 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) –Medicare database. χ2 and two-way analysis of variance were used to assess differences in patient- and disease-related characteristics. Five-year overall survival was examined using Kaplan-Meier survival analysis and Cox proportional hazards regression with propensity score weighting. Results Of the 24,847 patients with stage II cancer, 75% had one or more poor prognostic features. Adjuvant chemotherapy was received by 20% of patients with stage II disease and 57% of patients with stage III disease. After adjustment, 5-year survival benefit from chemotherapy was observed only for patients with stage III disease (hazard ratio[HR], 0.64; 95% CI, 0.60 to 0.67). No survival benefit was observed for patients with stage II cancer with no poor prognostic features (HR, 1.02; 95% CI, 0.84 to 1.25) or stage II cancer with any poor prognostic features (HR, 1.03; 95% CI, 0.94 to 1.13). Conclusion Among Medicare patients identified with stage II colon cancer, either with or without poor prognostic features, adjuvant chemotherapy did not substantially improve overall survival. This lack of benefit must be considered in treatment decisions for similar older adults with colon cancer.

Micrometastasis Volume in Lymph Nodes Determines Disease Recurrence Rate of Stage II Colorectal Cancer: A Prospective Multicenter Trial

“…A study by O'Connor and colleagues showed that 75% of the 24,847 stage II cancers had one or more poor prognostic features of perforation, T4 stage, poor histology, or others, and that survival benefit from adjuvant chemotherapy was not observed even with any poor prognostic features (32). The findings indicate that prognostic factors do not always predict patients' survival benefit by adjuvant chemotherapy.…”

GDNF increases cell motility in human colon cancer through VEGF–VEGFR1 interaction

“…Currently, patients with stage II colonic cancer are treated mostly by surgery alone. However, patients with high-risk stage II disease, with a prognosis similar to stage III patients, should be offered chemotherapy under the current guidelines (O'Connor et al 2011). In spite of the potentially curative resection, about 15-30% of patients with stage II disease will eventually develop recurrent locoregional disease or distant metastases within 5 years (Koebrugge et al 2011).…”

Beneficio de la quimioterapia adyuvante en pacientes con cáncer de colon: cohorte retrospectiva de un hospital clínico universitario

“…El porcentaje de pacientes en etapa II y III que recibió QT en esta serie fue de 22 y 70% respectivamente. Esto es similar a la frecuencia reportada por un estudio americano utilizando la base de datos del SEER (Surveillance, Epidemiology, and End Results) que incluyó a más de 23.000 etapa II y 17.000 pacientes en etapa III 22 . Los datos obtenidos en nuestro estudio reproducen la sobrevida alcanzada en estudios aleatorizados internacionales en esta patología 5,9,10 .…”