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Adjuvant Chemotherapy and Prognostic Factors in Stage II Colon Cancer - Izmir Oncology Group Study

  • Kucukzeybek, Yuksel (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Dirican, Ahmet (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Demir, Lutfiye (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Yildirim, Serkan (Department of Internal Medicine, Izmir Bozyaka Training and Research Hospital) ;
  • Akyol, Murat (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Yildiz, Yasar (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Bayoglu, Ibrahim Vedat (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Alacacioglu, Ahmet (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Varol, Umut (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Salman, Tarik (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Yildiz, Ibrahim (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Can, Huseyin (Department of Family Medicine, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Tarhan, Mustafa Oktay (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital)
  • Published : 2015.04.03

Abstract

Background: Although adjuvant chemotherapy is a standard treatment in stage III colon cancer, its benefit is not as clear for stage II patients. In this retrospective analysis, we aimed to evaluate the survival of patients with low-risk stage II colon cancer, the efficacy of adjuvant chemotherapy in high-risk stage II colon cancer patients, and prognostic factors in stage II disease. Materials and Methods: One hundred and seventeen patients who were diagnosed with stage II colon cancer between January 2006 and December 2011 were included in the study. Patients were stratified into two groups as being low-risk and high-risk according to risk factors for stage II disease. Adjuvant 5-fluorouracil-based chemotherapy were administered to the patients with risk factors. Results: Ninety-four patients were treated with adjuvant chemotherapy due to high risk factors and 23 were monitored without treatment. Median follow-up time was 43 months. In terms of disease free survival and overall survival, adjuvant chemotherapy did not provide a statistically significant difference. Univariate analysis demonstrated that bowel obstruction was the major risk factor for shortened disease-free survival, while bowel perforation and perineural invasion were both negative prognostic factors for overall survival. Conclusions: The recommendation of adjuvant chemotherapy for stage II colon cancer is not clear. In our study, it was found that adjuvant chemotherapy did not contribute to survival in high-risk stage II patients. Due to the fact that prognosis of stage II patients is good, many more patients will be needed for statistically significant differences in survival. Adjuvant chemotherapy containing 5 fluorouracil is being used to high-risk stage II patients although it is not a standard treatment approach.

Keywords

References

  1. Andre T, Boni C, Mounedji-Boudiaf L, et al (2004). Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med, 350, 2343-51. https://doi.org/10.1056/NEJMoa032709
  2. Artac M, Turhal NS, Kocer M, et al (2014). Do high risk features support the use of adjuvant chemotherapy in stage II colon cancer? a turkish oncology group study. Tumori, 100, 143-8.
  3. Baek JY, Yeo HY, Chang HJ, et al (2014). Serpin B5 is a CEA interacting biomarker for colorectal cancer. Int J Cancer, 134, 1595-604. https://doi.org/10.1002/ijc.28494
  4. Baghestani AR, Daneshvar T, Pourhoseingholi MA, Asadzade H (2014). Survival of colorectal cancer patients in the presence of competing-risk. Asia Pac J Cancer Prev, 15, 6253-5. https://doi.org/10.7314/APJCP.2014.15.15.6253
  5. Benson AB 3rd, Schrag D, Somerfield MR, et al (2004). American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol, 22, 3408-19. https://doi.org/10.1200/JCO.2004.05.063
  6. Cakar B, Varol U, Junushova B, et al (2013). Evaluation of the efficacy of adjuvant chemotherapy in patients with high risk stage II colon cancer. JBUON, 18, 372-376.
  7. Chang GJ, Rodriguez-Bigas MA, Skibber JM, et al (2007). Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst, 99, 433-41. https://doi.org/10.1093/jnci/djk092
  8. Chen HS, Sheen-Chen SM, (2000). Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery, 127, 370-6. https://doi.org/10.1067/msy.2000.104674
  9. Compton CC, Fielding LP, Burgart LJ, et al (2000). Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med, 124, 979-94.
  10. Eisenberg B, Decosse JJ, Harford F, et al (1982). Carcinoma of the colon and rectum: the natural history reviewed in 1704 patients. Cancer, 49, 1131-4. https://doi.org/10.1002/1097-0142(19820315)49:6<1131::AID-CNCR2820490611>3.0.CO;2-T
  11. Ferlay J, Shin HR, Bray F, et al (2008). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  12. Gill S, Loprinzi CL, Sargent DJ, et al (2004). Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol, 22, 1797-806. https://doi.org/10.1200/JCO.2004.09.059
  13. Gray R, Barnwell J, McConkey C, et al (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet, 370, 2020-9. https://doi.org/10.1016/S0140-6736(07)61866-2
  14. Kuebler JP, Wieand HS, O'Connell MJ, et al (2007). Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol, 25, 2198-204. https://doi.org/10.1200/JCO.2006.08.2974
  15. Labianca R, Nordlinger B, Beretta GD, et al (2013). Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 24, 64-72.
  16. Lai JH, Zhou YJ, Bin D, Qiangchen, Wang SY (2014). Clinical significance of detecting lymphatic and blood vessel invasion in stage II colon cancer using markers D2-40 and CD34 in combination. Asia Pac J Cancer Prev, 15, 1363-70. https://doi.org/10.7314/APJCP.2014.15.3.1363
  17. Meng J, Lu XB, Tang YX, et al (2013). Effects of allogeneic blood transfusion in patients with stage II colon cancer. Asia Pac J Cancer Prev, 14, 347-50. https://doi.org/10.7314/APJCP.2013.14.1.347
  18. Moertel CG, Fleming TR, Macdonald JS, et al (1990). Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med, 322, 352-8. https://doi.org/10.1056/NEJM199002083220602
  19. O'Connor ES, Greenblatt DY, LoConte NK, et al (2011). Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol, 29, 3381-8. https://doi.org/10.1200/JCO.2010.34.3426
  20. Ozdemir Y, Akin ML, Sucullu I, Balta AZ, Yucel E (2014). Pretreatment neutrophil/lymphocyte ratio as a prognostic aid in colorectal cancer. Asia Pac J Cancer Prev, 15, 2647-50. https://doi.org/10.7314/APJCP.2014.15.6.2647
  21. Quah HM, Chou JF, Gonen M, et al (2008). Identification of patients with high-risk stage II colon cancer for adjuvant therapy. Dis Colon Rectum, 51, 503-7. https://doi.org/10.1007/s10350-008-9246-z
  22. Ribic CM, Sargent DJ, Moore MJ, et al (2003). Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med, 349, 247-57. https://doi.org/10.1056/NEJMoa022289
  23. Sargent DJ, Marsoni S, Monges G, et al (2010). Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol, 28, 3219-26. https://doi.org/10.1200/JCO.2009.27.1825
  24. Siegel R, Desantis C, Jemal A,(2014). Colorectal cancer statistics, 2014. CA Cancer J Clin, 64, 104-17. https://doi.org/10.3322/caac.21220
  25. Talaiezadeh A, Tabesh H, Sattari A, Ebrahimi S (2013). Cancer incidence of southwest of Iran: first report from Khuzestan population-based cancer registry, 2002-2009. Asia Pac J Cancer Prev, 14, 7517-22. https://doi.org/10.7314/APJCP.2013.14.12.7517
  26. Tournigand C, Andre T, Bonnetain F, et al (2012). Adjuvant therapy with fluorouracil and oxaliplatin in stage II and elderly patients (between ages 70 and 75 years) with colon cancer: subgroup analyses of the multicenter international study of oxaliplatin, fluorouracil, and leucovorin in the adjuvant treatment of colon cancer trial. J Clin Oncol, 30, 3353-60. https://doi.org/10.1200/JCO.2012.42.5645
  27. Trivedi H, Chamarthy U, Dicarlo L, Herman J, Srkalovic G (2014). Prognostic factors of overall survivall for patients with stage II colon cancer. Acta Med Acad, 43, 134-43. https://doi.org/10.5644/ama2006-124.112
  28. Wilkinson NW, Yothers G, Lopa S, et al (2010). Long-term survival results of surgery alone versus surgery plus 5fluorouracil and leucovorin for stage II and stage III colon cancer: pooled analysis of NSABP C-01 through C-05. A baseline from which to compare modernadjuvant trials. Ann Surg Oncol, 17, 959-66. https://doi.org/10.1245/s10434-009-0881-y
  29. Wu X, Zhang J, He X, et al (2012). Postoperative adjuvant chemotherapy for stage II colorectal cancer: a systematic review of 12 randomized controlled trials. J Gastrointest Surg, 16, 646-55. https://doi.org/10.1007/s11605-011-1682-8
  30. Yothers G, O'Connell MJ, Allegra CJ, et al (2011). Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin Oncol, 29, 3768-74. https://doi.org/10.1200/JCO.2011.36.4539

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