title: The role of adjuvant chemotherapy in stage II colorectal cancer patients.
abstract: OBJECTIVE
  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.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, 11217, Taipei, Taiwan.
authors.forename: Hung-Hsin
authors.initials: HH
authors.lastname: Lin
authors.forename: Yu-Yao
authors.initials: YY
authors.lastname: Chang
authors.forename: Jen-Kou
authors.initials: JK
authors.lastname: Lin
authors.forename: Jeng-Kai
authors.initials: JK
authors.lastname: Jiang
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Lin
authors.forename: Yuan-Tzu
authors.initials: YT
authors.lastname: Lan
authors.forename: Shung-Haur
authors.initials: SH
authors.lastname: Yang
authors.forename: Huann-Sheng
authors.initials: HS
authors.lastname: Wang
authors.forename: Wei-Shone
authors.initials: WS
authors.lastname: Chen
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Lin
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005472:Fluorouracil