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Identification of Patients with High-Risk Stage II Colon Cancer for Adjuvant Therapy.

Quah, Hak-Mien M.D.; Chou, Joanne F. M.P.H.; Gonen, Mithat Ph.D.; Shia, Jinru M.D.; Schrag, Deborah M.D.; Landmann, Ron G. M.D.; Guillem, José G. M.D.; Paty, Philip B. M.D.; Temple, Larissa K. M.D.; Wong, W. Douglas M.D.; Weiser, Martin R. M.D.
Diseases of the Colon & Rectum: May 2008
doi: 10.1007/s10350-008-9246-z
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Purpose: 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 >=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.

(C) The ASCRS 2008