Efficacy of Postoperative Adjuvant Chemotherapy According to Prognostic Factor in Patients with Stage III Colon Cancer

Kiichi Sugimoto, Kazuhiro Sakamoto, Yuichi Tomiki, Michitoshi Goto, Yutaka Kojima, Hiromitsu Komiyama, Makoto Takahashi, Shun Ishiyama, Koichiro Niwa, Haruna Okubo

Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.

DOI: 10.4236/jct.2014.58088                

Abstract

Background: We retrospectively identified prognostic factors in patients with Stage III colon cancer and considered the effectiveness of postoperative adjuvant chemotherapy based on these prognostic factors. Methods: Two hundred and thirty four patients with lymph node metastases who underwent curative surgery for colon cancer between 1999 and 2005 were enrolled in the present study. Firstly, clinicopathological factors and survival data, were analyzed to determine prognostic factors related to cancer-specific survival. Secondly, we examined the effectiveness of postoperative adjuvant chemotherapy based upon these prognostic factors. Results: The multivariate analysis revealed that differentiation (P = 0.03, Hazard ratio = 2.50), lymphatic invasion (P = 0.02, Hazard ratio = 3.23) and the TNM classification, 7^th edition (P = 0.04, Hazard ratio = 1.94) were found to be significant independent prognostic factors. Among the patients classified as TNM IIIA, the recurrence-free survival rates were extremely good. Among the patients classified as IIIB and IIIC, there was no significant difference between the patients with and without postoperative adjuvant chemotherapy. Conclusion: The present study suggests that the patients with Stage IIIA colon cancer may not require postoperative adjuvant chemotherapy. The addition of oxaliplatin to 5-FU should be considered for the patients with Stage IIIB and IIIC colon cancer, for whom the prognoses are far from satisfactory.

Keywords

Colorectal Cancer, Postoperative Adjuvant Chemotherapy, Prognostic Factor, Stage III Colon Cancer, TNM Classification, 7^th Edition

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J. and Thun, M.J. (2009) Cancer Statistics, 2009. CA: A Cancer Journal for Clinicians, 59, 225-249. http://dx.doi.org/10.3322/caac.20006
[2]	Yoshida, M., Kondo, K. and Tada, T. (2010) The Relation between the Cancer Screening Rate and the Cancer Mortality Rate in Japan. The Journal of Medical Investigation, 57, 251-259. http://dx.doi.org/10.2152/jmi.57.251
[3]	Lembersky, B.C., Wieand, H.S., Petrelli, N.J., O’Connell, M.J., Colangelo, L.H., Smith, R.E., Seay, T.E., Giguere, J.K., Marshall, M.E., Jacobs, A.D., Colman, L.K., Soran, A., Yothers, G. and Wolmark, N. (2006) Oral Uracil and Tegafur plus Leucovorin Compared with Intravenous Fluorouracil and Leucovorin in Stage II and III Carcinoma of the Colon: Results from National Surgical Adjuvant Breast and Bowel Project Protocol C-06. Journal of Clinical Oncology, 24, 2059-2064. http://dx.doi.org/10.1200/JCO.2005.04.7498
[4]	Twelves, C., Wong, A., Nowacki, M.P., Abt, M., Burris 3rd, H., Carrato, A., Cassidy, J., Cervantes, A., Fagerberg, J., Georgoulias, V., Husseini, F., Jodrell, D., Koralewski, P., Kroning, H., Maroun, J., Marschner, N., McKendrick, J., Pawlicki, M., Rosso, R., Schüller, J., Seitz, J.F., Stabuc, B., Tujakowski, J., Van Hazel, G., Zaluski, J. and Scheithauer, W. (2005) Capecitabine as Adjuvant Treatment for Stage III Colon Cancer. New England Journal of Medicine, 352, 2696-2704. http://dx.doi.org/10.1056/NEJMoa043116
[5]	Kuebler, J.P., Wieand, H.S., O’Connell, M.J., Smith, R.E., Colangelo, L.H., Yothers, G., Petrelli, N.J., Findlay, M.P., Seay, T.E., Atkins, J.N., Zapas, J.L., Goodwin, J.W., Fehrenbacher, L., Ramanathan, R.K., Conley, B.A., Flynn, P.J., Soori, G., Colman, L.K., Levine, E.A., Lanier, K.S. and Wolmark, N. (2007) Oxaliplatin Combined with Weekly Bolus Fluorouracil and Leucovorin as Surgical Adjuvant Chemotherapy for Stage II and III Colon Cancer: Results from NSABP C-07. Journal of Clinical Oncology, 25, 2198-2204. http://dx.doi.org/10.1200/JCO.2006.08.2974
[6]	André, T., Boni, C., Navarro, M., Tabernero, J., Hickish, T., Topham, C., Bonetti, A., Clingan, P., Bridgewater, J., Rivera, F. and de Gramont, A. (2009) Improved Overall Survival with Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment in Stage II or III Colon Cancer in the MOSAIC Trial. Journal of Clinical Oncology, 27, 3109-3116. http://dx.doi.org/10.1200/JCO.2008.20.6771
[7]	NCCN (2013) http://www.nccn.org/
[8]	ESMO (2013) http://www.esmo.org/
[9]	NICE (2013) http://www.nice.org.uk/
[10]	André, T., Boni, C., Mounedji-Boudiaf, L., Navarro, M., Tabernero, J., Hickish, T., Topham, C., Zaninelli, M., Clingan, P., Bridgewater, J., Tabah-Fisch, I. and de Gramont, A., Multicenter International Study of Oxaliplatin/5-Fluorouracil/ Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) Investigators (2004) Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer. New England Journal of Medicine, 350, 2343-2351. http://dx.doi.org/10.1056/NEJMoa032709
[11]	Aballéa, S., Chancellor, J.V., Raikou, M., Drummond, M.F., Weinstein, M.C., Jourdan, S. and Bridgewater, J. (2007) Cost-Effectiveness Analysis of Oxaliplatin Compared with 5-Fluorouracil/Leucovorin in Adjuvant Treatment of Stage III Colon Cancer in the US. Cancer, 109, 1082-1089. http://dx.doi.org/10.1002/cncr.22512
[12]	Japanese Society for Cancer of the Colon and Rectum (2009) Japanese Classification of Colorectal Carcinoma. 2nd Edition, Kanehara & Co., Ltd., Tokyo.
[13]	Sobin, L.H., Gaspodarowicz, M. and Wittekind, C. (2009) TNM Classification of Malignant Tumors. 7th Edition, Wiley-Blackwell, New York.
[14]	Gunderson, L.L., Jessup, J.M., Sargent, D.J., Greene, F.L. and Stewart, A.K. (2010) Revised TN Categorization for Colon Cancer Based on National Survival Outcomes Data. Journal of Clinical Oncology, 28, 264-271. http://dx.doi.org/10.1200/JCO.2009.24.0952
[15]	Gunderson, L.L., Jessup, J.M., Sargent, D.J., Greene, F.L. and Stewart, A.K. (2010) Revised Tumor and Node Categorization for Rectal Cancer Based on Surveillance, Epidemiology, and End Results and Rectal Pooled Analysis Outcomes. Journal of Clinical Oncology, 28, 256-263. http://dx.doi.org/10.1200/JCO.2009.23.9194
[16]	Gao, P., Song, Y.X., Wang, Z.N., Xu, Y.Y., Tong, L.L., Sun, J.X., Yu, M. and Xu, H.M. (2013) Is the Prediction of Prognosis Not Improved by the Seventh Edition of the TNM Classification for Colorectal Cancer? Analysis of the Surveillance, Epidemiology, and Results (SEER) Database. BMC Cancer, 13, 123. http://dx.doi.org/10.1186/1471-2407-13-123
[17]	Sakamoto, J., Ohashi, Y., Hamada, C., Buyse, M., Burzykowski, T. and Piedbois, P., Meta-Analysis Group of the Japanese Society for Cancer of the Colon and Rectum, Meta-Analysis Group in Cancer (2004) Efficacy of Oral Adjuvant Therapy after Resection of Colorectal Cancer: 5-Year Results from Three Randomized Trials. Journal of Clinical Oncology, 22, 484-492.
[18]	Hamaguchi, T., Shirao, K., Moriya, Y., Yoshida, S., Kodaira, S. and Ohashi, Y., NSAS-CC Group (2011) Final Results of Randomized Trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC). Cancer Chemotherapy and Pharmacology, 67, 587-596. http://dx.doi.org/10.1007/s00280-010-1358-1
[19]	Arredondo, J., Pastor, C., Baixauli, J., Rodríguez, J., González, I., Vigil, C., Chopitea, A. and Hernández-Lizoáin, J.L. (2013) Preliminary Outcome of a Treatment Strategy Based on Perioperative Chemotherapy and Surgery in Patients with Locally Advanced Colon Cancer. Colorectal Disease, 15, 552-557. http://dx.doi.org/10.1111/codi.12119
[20]	FOxTROT Collaborative Group (2012) Feasibility of Perioperative Chemotherapy for Locally Advanced, Operable Colon Cancer: The Pilot Phase of a Randomised Controlled Trial. The Lancet Oncology, 13, 1152-1160. http://dx.doi.org/10.1016/S1470-2045(12)70348-0