Efficacy of 5-FU/LV plus CPT-11 as first-line adjuvant chemotherapy for stage IIIa colorectal cancer

Mukai, Masaya; Okada, Kazutake; Fukumitsu, Hiroshi; Yazawa, Naoki; Hoshikawa, Tatsuhiko; Tajima, Takayuki; Hirakawa, Hitoshi; Ogoshi, Kyouji; Makuuchi, Hiroyasu

doi:10.3892/or_00000481

Cited by 12 publications

(13 citation statements)

References 18 publications

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“…At least 12 lymph nodes were collected from patients in the two groups following D2 or D3 resection according to the Japanese classification (28)(29)(30). The postoperative adjuvant chemotherapy regimens were as follows: No chemotherapy in stage I, only oral anticancer agents (UFT/PSK) in stage II, and modified 5-fluorouracil (5-FU)/leucovorin (LV) or modified FOLFIRI (5-FU/LV+CPT-11) for ≥6 months in stage III (25,(31)(32)(33)(34)(35)(36). To detect metastasis/recurrence, ultrasound scan (US) and computed tomography (CT) were performed 3-4 times annually, and patients in whom US and CT simultaneously identified metastatic/recurrent disease were classified as positive for metastasis/recurrence (25,31-36).…”

Section: Introductionmentioning

confidence: 99%

Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

et al. 2017

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Abstract.In recent years, the use of laparoscopic surgery has been expanded to include radical curative resection. In a previous study, 212 patients with primary colorectal cancer (stages I-III) underwent radical curative resection by hand-assisted laparoscopic surgery (HALS) (n=98) or conventional laparotomy (CL) (n=114) and were compared with respect to 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS). The study included 210/212 patients who were followed up to 5 years, including 96 patients who underwent HALS and 114 treated with CL. The two groups were matched for stage, clinical background, and postoperative management. Patient characteristics were compared and the 5Y-RFS and 5Y-OS were determined. The 5-year follow-up rate was 97.6%. In stage I-III patients, 5Y-RFS and 5Y-OS showed no significant differences between HALS and CL. The patients with stage I disease accounted for 41.7% (40/96) of the patients undergoing HALS, while stage I patients only accounted for 23.7% (27/114) of the patients undergoing CL, and the difference was significant (P= 0.005). Stage II patients undergoing CL were older than those treated with HALS (P=0.017). However, there were no differences in the characteristics of stage III patients undergoing HALS or CL. In conclusion, HALS achieved a similar survival to CL in patients with stage I to III colorectal cancer. Compared with CL, HALS was performed more safely and achieved superior cosmetic results. IntroductionIn recent years, the indications for laparoscopic surgery have been expanded to include radical curative resection of early to advanced colorectal cancer and palliative surgery for stage IV disease (1-6). In Japan, laparoscopy-assisted colorectal surgery (pure LACS) is widely used. However, pure LACS has several disadvantages, such as requiring at least 2 physicians who are familiar with the procedure and prolonging the operating time, as well as needing more staff and limiting the availability of operating theaters. Previously, it was reported that pure LACS achieves the same or better outcomes as conventional laparotomy (CL) with regard to wound infection, hospital stay, and survival, together with superior cosmetic results (7-10). In Europe and the USA, hand-assisted laparoscopic surgery (HALS) (HH) is more widely used than pure LACS. HH is characterized by: i) Providing the operator with palpation/tactile sensation, and allowing full grasping manipulation with the left hand and the possibility of smoothly removing even large and heavy tumors; ii) a shorter operating time than for pure LACS; and iii) a more rapid learning curve than for pure LACS (8,9,[11][12][13][14][15][16][17].In Japan, various surgical procedures are employed for colorectal cancer, including pure LACS (30-40%), CL (~50%), and other methods such as HALS and microincisional surgery (18). HALS is often regarded as being an optimal medium between CL and pure LACS (8,9,(18)(19)(20)(21)(22)(23). In Japan, HALS initially became popular for a short period of time during the introdu...

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Section: Introductionmentioning

confidence: 99%

Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

et al. 2017

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“…In patients who were not indicated for surgery, anticancer agents other than those mentioned above were administered as second-line treatment. Radiotherapy was added in the case of rectal cancer for the local recurrence involving the pelvic floor (12)(13)(14). As a general rule, outpatient follow-up included measurement of tumor markers 3-4 times per year and ultrasonography/computed tomography (US/CT) 3-4 times a year, with recurrence/metastasis being confirmed by both US and CT (10,13).…”

Section: Methodsmentioning

confidence: 99%

“…In general, Stage II patients received postoperative adjuvant chemotherapy with oral UFT/PSK (Krestin) for 12 months or longer (8)(9)(10). Stage III patients received intravenous 5FU/LV or 5FU/LV in combination with CPT-11 for 6 months after surgery, and then received oral UFT/Uzel (an oral calcium folinate) or UFT/PSK for 12 months or longer (11)(12)(13). In principle, surgical resection was chosen as the first-line treatment for postoperative recurrence/metastasis.…”

Section: Methodsmentioning

confidence: 99%

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

Mukai

Kishima²,

Yamazaki³

et al. 2011

Oncol Rep

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Abstract.The 5-year relapse-free survival rate (5Y-RFS) and 5-year overall survival rate (5Y-OS) were investigated in 766 patients with stage II/III colorectal cancer (CRC). The Stage II group included 283 patients with colon cancer (CC), 40 patients with rectosigmoid junction cancer (RSC), and 74 patients with rectal cancer (RC), while the Stage III group comprised 226 patients with CC, 52 patients with RSC, and 91 patients with RC. Stage III patients with RC were further divided into 68 patients with Ra cancer (Ra, rectum/above the peritoneal reflection) and 23 patients with Rb cancer (Rb, rectum/below the peritoneal reflection). Then the 5Y-RFS and 5Y-OS were calculated for each category or subcategory. The 5Y-RFS/5Y-OS was 80.3/80.6% for Stage II patients and 63.7% (p<0.001)/66.2% (p<0.001) for Stage III patients. In the Stage II group, the survival rates were 82.9/81.2% for CC, 77.6/74.8% for RSC, and 72.9/80.5% for RC, with no significant differences between each category. In the Stage III group, the survival rates were 69.3/72.8% for CC, 71.6/77.7% for RSC, and 46.5/46.2% for RC. There was no significant difference of survival for CC vs. RSC, but significant differences were noted for CC vs. RC (p<0.001/p<0.001) and RSC vs. RC (p=0.008/p=0.007). In the Stage III group, survival rates were 71.6/77.7% for RSC, 47.6/44.8% for Ra, and 45.7/51.3% for Rb, with significant differences for RSC vs. Ra (p=0.013/ p=0.005) and RSC vs. Rb (p=0.026/p=0.180), but not for Ra vs. Rb. These results suggest that Stage II/III RS cancer should be classified as colon cancer and should not be considered an independent tumor type.

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“…It was considered to be the result of persistent tumor immunity leading to eradication of single cells. Also, the number of clusters is presumed to be increased compared with that in patients who have stage II/N0-localized tumors, and more potent postoperative adjuvant chemotherapy would be required for stage III patients with a high risk of recurrence (31,32). Aside from various factors such as the host immunity and tumor susceptibility to anticancer agents, the results of this study suggested that the presence of single cells + clusters of ONCs was related to a high risk of recurrence based on its high sensitivity, while ONCs are a useful negative indicator for identifying the low-risk group because the absence of ONCs showed a high NPV.…”

Section: -------------------------------------------------mentioning

confidence: 99%

“…We therefore investigated the presence of ONC clusters consisting of 2-20 tumor cells for which viability can be easily judged in addition to the conventional assessment of single cells. Clusters are assumed to be either spheres ≤0.2 mm in diameter or structures like a bunch of grapes, but it is not known at present whether or not there is an interstitial component connecting the individual cancer cell or whether the clusters contain cancer stem cells with resistance to chemotherapy agents that transmit important information for tumor survival (18,32). However, it was considered easier compared with single cells to judge the proliferative capacity, based on the nuclear structure, cytoplasmic morphology and staining.…”

Section: -------------------------------------------------mentioning

confidence: 99%

Occult neoplastic cells in the lymph node sinuses and recurrence/metastasis of stage III/Dukes' C colorectal cancer

Sekido

Mukai²,

Kishima³

et al. 2011

Oncol Rep

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Abstract.Lymph nodes from patients with colorectal cancer were immunohistochemically stained for cytokeratin to investigate the relationship between the presence of occult neoplastic cells (ONCs) and recurrence/metastasis. A total of 80 patients with stage III/Dukes' C colorectal cancer were divided into 16 patients who developed recurrence/metastasis (recurrence group) and 64 patients without recurrence (nonrecurrence group). ONCs were compared between the two groups with respect to i) single cells (≥3 floating ONCs), ii) clusters of cells (1 or more floating aggregates of 2-20 ONCs) and iii) single cells + clusters. When single cells were detected, the sensitivity for recurrence was 87.5% (14/16, p=0.002), the positive predictive value (PPV) was 32.6% (14/43), the specificity was 54.7% (35/64) and the negative predictive value (NPV) was 94.6% (35/37). For clusters, the sensitivity was 87.5% (14/16, p<0.001), PPV was 41.2% (14/34), specificity was 68.8% (44/64) and NPV 95.7% (44/46). With single cells + clusters, the values were 87.5% (14/16, p<0.001), 48.3% (14/29), 76.6% (49/64) and 96.1% (49/51), respectively. These results suggest that the detection of single cells + clusters is a sensitive indicator of a high risk of recurrence/metastasis, while ONCs are useful for identifying the low-risk group of patients with stage III colorectal cancer. IntroductionThe 5-year survival rate of Japanese patients who have stage II/ Dukes' B colorectal cancer without lymph node metastasis and receive curative resection is approximately 80% (colon, 84.5±2.8%; rectum, 79.8±4.0%), whereas the 5-year survival rate is considerably lower at approximately 60% (colon, 74.0±3.5%; rectum, 64.7±4.3%) for patients with stage III/ Dukes' C colorectal cancer and lymph node metastasis who undergo curative resection (1-4). Thus, recurrence/metastasis develops in 30-40% of stage III/Dukes' C patients after curative resection and can be fatal (2,4). According to the pathological concept of breast cancer, positive lymph node metastasis indicates systemic disease with the potential for metastasis to other organs and the presence or absence of lymph node metastasis is considered to be one of the most important clinical markers (5,6). Hematogenous metastasis to the liver or the lungs in patients with lymph node metastasis who undergo curative resection is presumed to occur when cancer cells circulating in the blood during the perioperative period, escape the immune system enter the microcirculation of the liver or the lungs, and find appropriate microenvironment for growth and proliferation (7-10). Various reports have been published about the close relationship between recurrence/metastasis of cancer and detection of occult neoplastic cells (ONCs) positive for cytokeratin immunohistochemical staining and floating in the sinuses of lymph nodes distant from the primary tumors (11-15). ONCs can be semiquantified by a relatively simple immunostaining method and represent floating tumor cells target trapped in the microcirculation of the lymph node...

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Efficacy of 5-FU/LV plus CPT-11 as first-line adjuvant chemotherapy for stage IIIa colorectal cancer

Cited by 12 publications

References 18 publications

Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

Occult neoplastic cells in the lymph node sinuses and recurrence/metastasis of stage III/Dukes' C colorectal cancer

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