Defining a high-risk subgroup with colon cancer stages I and II for possible adjuvant therapy.
OBJECTIVE
Adjuvant therapy is not routinely recommended in UICC stages I and II colon cancer, but may be considered for high-risk patients. Our aim is to identify clinicopathologic characteristics in colon cancer stages I and II, which are associated with an increased risk of tumour recurrence and tumour-related death.


METHODS
We analysed our prospectively documented clinical database of 775 patients with colon cancer stages I and II, which underwent curative resection between 1982 and 2006. No adjuvant chemotherapy was applied. The median follow-up time was 80 months.


RESULTS
For the entire study group, 5- and 10-year tumour-specific survival probabilities were 94.8+/-0.9% and 91.0+/-1.4%, respectively. Multivariate analysis identified three tumour characteristics as independent prognostic factors: lymphatic vessel invasion (p=0.034), poor tumour grading (G3/G4) (p=0.020) and extended tumour length (6 cm) (p=0.042). Five-year (10-year) tumour-specific survival for patients without any of the poor prognostic tumour characteristics (ppTCs) was 96.0% (94.7%). There was a significantly increased risk for tumour-related death with increasing numbers of ppTCs (p<0.001). While patients with only one ppTC had a 5-year (10-year) tumour-specific survival of 94.8% (88.9%), it decreased to 88.9% (78.4%) for patients with two ppTCs (hazard ratio (HR) 3.69, 95% confidence interval (CI) 1.67-8.13) and to 87.5% (72.9%) for patients with all three ppTCs (HR 6.56, 95% CI 1.50-26.62).


CONCLUSIONS
Patients with stage I or II colon cancer have a favourable prognosis after radical resection. The presence of two or three poor prognostic tumour characteristics identifies a small patient subgroup (12%) with an increased risk of tumour-related death that may be considered for adjuvant chemotherapy.
Gertler
Ralf
R
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. gertler@chir.med.tu-muenchen.de
Rosenberg
Robert
R
Schuster
Tibor
T
Friess
Helmut
H
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis
D000970:Antineoplastic Agents