title: Prognostic and Predictive Model for Stage II Colon Cancer Patients With Nonemergent Surgery: Who Should Receive Adjuvant Chemotherapy?
abstract: No ideal prognostic model has been applied to clearly identify which suitable high-risk stage II colon cancer patients with negative margins undergoing nonemergent surgery should receive adjuvant chemotherapy routinely. Clinicopathologic and prognostic data of 333 stage II colon cancer patients who underwent D2 or D3 lymphadenectomy during nonemergent surgery were retrospectively analyzed. Four pathologically determined factors, including adjacent organ involvement (RR 2.831, P = 0.001), histologic differentiation (RR 2.151, P = 0.009), lymphovascular invasion (RR 4.043, P < 0.001), and number of lymph nodes retrieved (RR 2.161, P = 0.011), were identified as independent prognostic factors on multivariate analysis. Importantly, a simple cumulative scoring system clearly categorizing prognostic risk groups was generated: risk score = ∑ coefficient' × status (AOI + histological differentiated + lymphovascular invasion + LNs retrieved). Our new prognostic model may provide valuable information on the impact of lymphovascular invasion, as well as powerfully and reliably predicting prognosis and recurrence for this particular cohort of patients. This model may identify suitable patients with an R0 resection who should receive routine postoperative adjuvant therapy and may help clinicians to facilitate individualized treatment. In this study, we aim to provide an ideal and quantifiable method for clinical decision making in the nonemergent surgical treatment of stage II colon cancer. Our prognostic and predictive model should be applied in multicenter, prospective studies with large sample sizes, in order to obtain a more reliable clinical recommendation.
authors.affiliation: From the Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang (C-DZ, B-QS, Y-JZ, D-QD); Department of General Surgery, Dalian Friendship Hospital, Dalian (J-NW); Cancer Center, the Fourth Affiliated Hospital of China Medical University (D-QD); and Cancer Research Institute, China Medical University, Shenyang, PR China (D-QD, J-QC).
authors.forename: Chun-Dong
authors.initials: CD
authors.lastname: Zhang
authors.forename: Ji-Nan
authors.initials: JN
authors.lastname: Wang
authors.forename: Bai-Qiang
authors.initials: BQ
authors.lastname: Sui
authors.forename: Yong-Ji
authors.initials: YJ
authors.lastname: Zeng
authors.forename: Jun-Qing
authors.initials: JQ
authors.lastname: Chen
authors.forename: Dong-Qiu
authors.initials: DQ
authors.lastname: Dai
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult