The role of adjuvant chemotherapy in stage II colorectal cancer patients.

Abstract

PURPOSE:

Adjuvant chemotherapy use in stage II colorectal cancer (CRC) is debated. We evaluated the prognostic significance of clinicopathological features recommended by most guidelines for identifying high-risk stage II CRC and adjuvant chemotherapeutic response.

METHODS:

We enrolled 1,039 stage II CRC patients who underwent curative surgery at Taipei Veterans General Hospital from January 2005 to December 2010. Seventy-seven patients who received radiotherapy were excluded. The endpoint was disease-free survival.

RESULTS:

Of 962 patients, 37 had stage T4 tumors; 50, lymphovascular invasion; 39, poor differentiation; 249, preoperative carcinoembryonic antigen (CEA) levels >5 ng/mL; and 53 underwent emergent operations. One hundred ninety-four patients received 5-fluorouracil-based adjuvant chemotherapy. During a median follow-up period of 60.2 months, recurrence developed in 110 patients (11.4 %). The 5-year disease-free survival (DFS) was 87.6 %. In multivariate analysis, preoperative CEA >5 ng/ml (p = 0.001), emergent operation for obstruction/perforation (p = 0.008), lymphovascular invasion (p = 0.014), and T4 disease (p = 0.030) were significantly associated with poor DFS. High-risk stage II patients (n = 484) benefited from adjuvant chemotherapy (5-year DFS with and without adjuvant chemotherapy, 87.3 vs. 78.9 %; p = 0.028).

CONCLUSIONS:

Adjuvant chemotherapy improved DFS in high-risk stage II CRC patients, but not in low-risk patients.

• Authors: Hung-Hsin Lin, Yu-Yao Chang, Jen-Kou Lin, Jeng-Kai Jiang, Chun-Chi Lin, Yuan-Tzu Lan, Shung-Haur Yang, Huann-Sheng Wang, Wei-Shone Chen, Tzu-Chen Lin, Shih-Ching Chang
• Journal: International journal of colorectal disease (Int J Colorectal Dis) Vol. 29 Issue 10 Pg. 1237-43 (Oct 2014) ISSN: 1432-1262 [Electronic] Germany
• PMID: 25024041 (Publication Type: Journal Article)

Chemical References

• Fluorouracil

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Chemotherapy, Adjuvant
• Colorectal Neoplasms (drug therapy, mortality, pathology, surgery)
• Disease-Free Survival
• Female
• Fluorouracil (therapeutic use)
• Humans
• Male
• Middle Aged
• Neoplasm Metastasis
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Risk Factors
• Young Adult