Prognostic significance of adjuvant radiation therapy in adenocarcinoma of the cecum

Abstract

PurposeLocal recurrence is a common failure pattern in adenocarcinoma of the cecum. This study aimed to investigate the potential role of adjuvant radiation therapy on oncologic outcomes of patients with adenocarcinoma of the cecum.Materials and MethodsThis retrospective study was carried out at three large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of 162 patients with adenocarcinoma of the cecum that were treated and followed up between 2000 and 2013. All the patients had undergone a right hemicolectomy and received chemotherapy with (n = 48) or without (n = 114) adjuvant radiation therapy.ResultsThe subjects were 65 females and 97 males with a median age of 56 years (range, 17 to 90 years) at diagnosis. The 5-year local control (LC), disease free survival (DFS), and overall survival (OS) rates were 72.7%, 57.2%, and 62.6% respectively. In a multivariate analysis, age, tumor stage, node stage, and adjuvant radiation therapy were determined to be independent prognostic factors. Age more than 55 years (hazard ratio [HR] = 1.0; 95% confidence interval [CI], 0.06–0.32; p = 0.003], T4 stage (HR = 6.8; 95% CI, 3.07–15.36; p < 0.001), node positive disease (HR = 4.2; 95% CI, 1.94–9.13; p < 0.001), and the absence of adjuvant radiation therapy (HR = 3.0; 95% CI, 1.39–6.46; p = 0.005) had a negative influence on OS.ConclusionAdjuvant radiation therapy significantly improves DFS and OS in patients with adenocarcinoma of the cecum.

Prognostic analysis and beneficiary identification of adjuvant external beam radiotherapy for stage pT4b sigmoid colon cancer

“…Lymph node evaluation is often a critical factor in predicting the prognosis of colon cancer and is also a deciding factor for postoperative treatment 2 , 33 , 34 . However, LND number other than lymph node classification was independently associated with OS, as confirmed in this study, although the cutoff values for LND number varied in previous reports 3 , 35 , 36 . In this study, the cutoff value of LND number was 12, as recommended by the National Comprehensive Cancer Network (NCCN) guideline; based on this threshold, LND number < 12 increased the risk of death by nearly two-fold.…”

“…Whether age affects LC and DFS remains controversial 3 , 27 , 28 ; however, aging is an independent risk factor for poor prognosis of colon cancer, with different aging cutoff values 4 , 8 , 21 , 29 . In this study, these cutoff values were 50 and 70 years and the proportion of patients aged ≥ 70 years was as high as 39.1%.…”

“…The following data were also collected and categorized as follows: insurance (insured, uninsured, or unknown), age at diagnosis (< 50 years, 50–69 years, or ≥ 70 years), sex (male or female), race (white, black, others, or unknown), marital status (married, others, or unknown), differentiation status (well, moderate, poor, undifferentiated, or unknown), tumor size (< 3 cm, 3–4.9 cm, ≥ 5 cm, or unknown) 3 , 19 , serum carcinoembryonic antigen (CEA) level (elevated, normal, or unknown), perineural invasion (PNI) status (yes, no, or unknown), N classification (N0, N1, N2, or unknown), lymph node dissection (LND) number (< 12, ≥ 12, or unknown) 20 , adjuvant EBRT (yes or no), and survival (months). Data on adjuvant chemotherapy were not extracted in this study, mainly because it was hard to distinguish unknown chemotherapy from no chemotherapy in the SEER database 19 , 21 , although adjuvant chemotherapy is an important prognostic factor of colon cancer.…”

“…Radical surgery followed by adjuvant chemotherapy is still the preferred curative treatment for locally advanced colon cancer; however, the prognosis remains unsatisfactory, with a 5-year overall survival (OS) rate of 52–64% 2 . Although distant metastasis is decreasing with the development of modern systemic therapy in recent decades, the reported morbidity of local recurrence ranges from 10 to 40% 3 – 6 , underscoring the role of adjuvant radiotherapy. However, the clinical efficacy of adjuvant radiotherapy, as well as its safety and feasibility, have long been questioned 7 , 8 .…”

Nonmucinous adenocarcinoma of the cecum presenting as appendicitis complicated by hepatic abscess

“…Adjuvant chemotherapy is generally advised for stage III colon cancer and often for high-risk stage II disease. There is currently minimal recommendation for radiation therapy, although there is some research demonstrating benefit [8].…”