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International Journal of Colorectal Disease

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01-02-2013 | Original Article

Factors predicting worse prognosis in patients affected by pT3 N0 colon cancer: long-term results of a monocentric series of 137 radically resected patients in a 5-year period

Authors: Roberto Biffi, Edoardo Botteri, Emilio Bertani, Maria Giulia Zampino, Sabina Cenciarelli, Fabrizio Luca, Simonetta Pozzi, Maria Laura Cossu, Antonio Chiappa, Nicole Rotmensz, Barbara Bazolli, Elena Magni, Angelica Sonzogni, Bruno Andreoni

Published in: International Journal of Colorectal Disease | Issue 2/2013

Abstract

Background and purpose

For patients with Stage II colon cancer, the use of adjuvant chemotherapy remains controversial. The purpose of this study was to identify clinical and/or pathological findings related to a worse prognosis in this category of patients.

Patients and methods

We retrospectively analyzed the data of consecutive patients, extracted by an institutional Tumour Registry, admitted to an affiliated University Hospital in Milan (European Institute of Oncology) for adenocarcinoma of the colon (all sites), between 2000 and 2005, and having a final pT3 N0 pathology staging after curative surgery. Adjuvant chemotherapy was decided as a result of a medical decision within a multidisciplinary Tumor Board.

Results

Data of 137 patients were obtained, with a median follow-up of 77 months (range 6–131). Patients who received chemotherapy were younger than patients who did not. Nine patients out of 137 (6.5 %) died as a consequence of colon cancer recurrence; four of them had received adjuvant chemotherapy. Only histological grade III and mucinous histotype were found to impact on cumulative incidence of colon-related events (p 0.03 and 0.02, respectively); no impact was found on cumulative incidence of colonic neoplasm recurrence-related deaths (p 0.74 and 0.74, respectively). Number of analyzed LNs (lymph nodes) emerged as a factor possibly affecting the cumulative incidence of colon-related events (p 0.09) as well as the cumulative incidence of colonic neoplasm recurrence-related deaths (p 0.10). The risk of events was inversely proportional to the number of dissected LNs, even over 20 up to about 25 LNs. Never-smokers exhibited a lower incidence of colon-related events, although the difference was not statistically significant (p 0.09). All other analyzed variables did not show any impact on survival rate, including age, gender, ASA score, BMI, site of colonic neoplasm, multifocality, perivascular invasion, and use of adjuvant chemotherapy.

Conclusions

Histology grading G3 and mucinous histotype were predictors of worse outcome. Efforts to improve LN evaluation should result in clinically significant improvements in outcome, and also the quality of care for patients with radically resected stage II colon cancer.

Greene FL, Page DL, Fleming ID et al (eds) (2002) AJCC Cancer Staging Handbook, 6th edn. Springer, New York

Greene FL, Stewart AK, Norton HJ (2002) A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg 236:416–421PubMedCrossRef

Greene FL, Stewart AK, Norton HJ (2004) New tumor-node-metastasis staging strategy for node positive (stage III) rectal cancer: an analysis. J Clin Oncol 22:1778–1784PubMedCrossRef

Meyerhardt JA, Mayer RJ (2005) Systemic therapy for colorectal cancer. N Engl J Med 352:476–487PubMedCrossRef

O’Connell JB, Maggard MA, Ko CY (2004) Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 96:1420–1425PubMedCrossRef

Gill S, Loprinzi CL, Sargent DJ et al (2004) Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 22:1797–1806PubMedCrossRef

Benson AB III, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419PubMedCrossRef

Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP (2000) American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 88:1739–1757PubMedCrossRef

Cunningham D, Atkin W, Lenz HJ et al (2010) Colorectal cancer. Lancet 20(375):1030–1047CrossRef

10.

Botteri E, Iodice S, Maisonneuve P et al (2009) Case mix at the European Institute of Oncology: first report of the Tumour Registry, years 2000–2002. Ecancermedsci. doi:10.3332/ecancer.2009.149

11.

Krasna MJ, Flancbaum L, Cody RP et al (1988) Vascular and neural invasion in colorectal carcinoma. Incidence and prognostic significance. Cancer 61:1018–1023PubMedCrossRef

12.

Wanebo HJ, Rao B, Pinsky CM et al (1978) Preoperative carcinoembryonic antigen level as a prognostic indicator in colorectal cancer. N Engl J Med 299:448–451PubMedCrossRef

13.

Wolmark N, Fisher B, Wieand HS et al (1984) The prognostic significance of preoperative carcinoembryonic antigen levels in colorectal cancer. Results from NSABP (National Surgical Adjuvant Breast and Bowel Project) clinical trials. Ann Surg 199:375–382PubMedCrossRef

14.

Moertel CG, Fleming TR, Macdonald JS et al (1995) Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. J Clin Oncol 13:2936–2943PubMed

15.

Durrleman S, Simon R (1989) Flexible regression models with cubic splines. Stat Med 8:551–561PubMedCrossRef

16.

Mamounas E, Wieand S, Wolmark N et al (1999) Comparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). J Clin Oncol 17:1349–1355PubMed

17.

Quasar Collaborative Group (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised trial. Lancet 370:2020–2029CrossRef

18.

Jonker DJ, Spithoff K, Maroun J, Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-based Care (2011) Adjuvant systemic chemotherapy for Stage II and III colon cancer after complete resection: an updated practice guideline. Clin Oncol (R Coll Radiol) 23(5):314–322CrossRef

19.

Winn R, McClure J (2003) The NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 1:9

20.

Andre T, Boni C, Navarro M et al (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as an adjuvant treatment in stage II and III colon cancer in the MOSAIC trial. J Clin Oncol 27:3109–3116PubMedCrossRef

21.

Goldstein NS (2002) Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 26:179–189PubMedCrossRef

22.

Sarli L, Bader G, Iusco D et al (2005) Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 41:272–279PubMedCrossRef

23.

Swanson RS, Compton CC, Stewart AK, Bland KI (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65–71PubMedCrossRef

24.

Baxter NN, Virnig DJ, Rothenberger DA et al (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225PubMedCrossRef

25.

Bui L, Rempel E, Reeson D, Simunovic M (2006) Lymph node counts, rates of positive lymph nodes, and patient survival for colon cancer surgery in Ontario, Canada: a population-based study. J Surg Oncol 93:439–445PubMedCrossRef

26.

Jestin P, Pahlman L, Glimelius B, Gunnarsson U (2005) Cancer staging and survival in colon cancer is dependent on the quality of the pathologists’ specimen examination. Eur J Cancer 41:2071–2078PubMedCrossRef

27.

Lemmens VE, Verheij CD, Janssen-Heijnen ML et al (2006) Mixed adherence to clinical practice guidelines for colorectal cancer in the Southern Netherlands in 2002. Eur J Surg Oncol 32:168–173PubMedCrossRef

28.

Maurel J, Launoy G, Grosclaude P et al (1998) Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based study. Cancer 82:1482–1486PubMedCrossRef

29.

Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441PubMedCrossRef

30.

Carloss H, Huang B, Cohen A, Carloss E, Wyatt S, Tucker T (2004) The impact of number of lymph nodes removed on five-year survival in stage II colon and rectal cancer. J Ky Med Assoc 102:345–347PubMed

31.

Wong JH, Bowles BJ, Bueno R, Shimizu D (2002) Impact of the number of negative nodes on disease-free survival in colorectal cancer patients. Dis Colon Rectum 45:1341–1348PubMedCrossRef

32.

Koebrugge B, Vogelaar FJ, Lips DJ, Pruijt JF, van der Linden JC, Ernst MF, Bosscha K (2011) The number of high-risk factors is related to outcome in stage II colonic cancer patients. Eur J Surg Oncol 37(11):964–970PubMedCrossRef

Title: Factors predicting worse prognosis in patients affected by pT3 N0 colon cancer: long-term results of a monocentric series of 137 radically resected patients in a 5-year period
Authors: Roberto Biffi
Edoardo Botteri
Emilio Bertani
Maria Giulia Zampino
Sabina Cenciarelli
Fabrizio Luca
Simonetta Pozzi
Maria Laura Cossu
Antonio Chiappa
Nicole Rotmensz
Barbara Bazolli
Elena Magni
Angelica Sonzogni
Bruno Andreoni
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 2/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-012-1563-y

At a glance: The STEP trials

Springer Medicine

Factors predicting worse prognosis in patients affected by pT3 N0 colon cancer: long-term results of a monocentric series of 137 radically resected patients in a 5-year period

Abstract

Background and purpose

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background and purpose

Patients and methods

Results

Conclusions

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