Identification of patients with high-risk stage II colon cancer for adjuvant therapy.
OBJECTIVE
Adjuvant therapy for Stage II colon cancer remains controversial but may be considered for patients with high-risk features. The purpose of this study was to assess the prognostic significance of commonly reported clinicopathologic features of Stage II colon cancer to identify high-risk patients.


METHODS
We analyzed a prospectively maintained database of patients with colon cancer who underwent surgical treatment from 1990 to 2001 at a single specialty center. We identified 448 patients with Stage II colon cancer who had been treated by curative resection alone, without postoperative chemotherapy.


RESULTS
With median follow-up of 53 months, 5-year disease-specific survival for this cohort was 91 percent. Univariate and multivariate analyses identified three independent features that significantly affected disease-specific survival: tumor Stage T4 (hazard ratio (HR), 2.7; 95 percent confidence interval (CI), 1.1-6.2; P = 0.02), preoperative carcinoembryonic antigen > 5 ng/ml (HR, 2.1; 95 percent CI, 1.1-4.1; P = 0.02), and presence of lymphovascular or perineural invasion (HR, 2.1; 95 percent CI, 1-4.4; P = 0.04). Five-year disease-specific survival for patients without any of the above poor prognostic features was 95 percent; five-year disease-specific survival for patients with one of these poor prognostic features was 85 percent; and five-year disease-specific survival for patients with > or = 2 poor prognostic features was 57 percent.


CONCLUSIONS
Patients with Stage II colon cancer generally have an excellent prognosis. However, the presence of multiple adverse prognostic factors identifies a high-risk subgroup. Use of commonly reported clinicopathologic features accurately stratifies Stage II colon cancer by disease-specific survival. Those identified as high-risk patients can be considered for adjuvant chemotherapy and/or enrollment in investigational trials.
Quah
Hak-Mien
HM
Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Chou
Joanne F
JF
Gonen
Mithat
M
Shia
Jinru
J
Schrag
Deborah
D
Landmann
Ron G
RG
Guillem
José G
JG
Paty
Philip B
PB
Temple
Larissa K
LK
Wong
W Douglas
WD
Weiser
Martin R
MR
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome