Cancer Res Treat.  2018 Oct;50(4):1149-1163. 10.4143/crt.2017.194.

Effect of Adjuvant Chemotherapy on Stage II Colon Cancer: Analysis of Korean National Data

• Kim MK
• Won DD
• Park SM
• Kim T
• Kim SR
• Oh ST
• Sohn SK
• Kang MY
• Lee IK

• KMID: 2424788
• DOI: http://doi.org/10.4143/crt.2017.194

Abstract

PURPOSE
Debates exist regarding the effectiveness of adjuvant chemotherapy for stage II colon cancer. This study aimed to investigate the current status of adjuvant chemotherapy and its impact on survival for Korean stage II colon cancer patients by analyzing the National Quality Assessment data.
MATERIALS AND METHODS
A total of 7,880 patientswho underwent curative resection for stage II colon adenocarcinoma between January 2011 andDecember 2014 in Koreawere selected randomly as evaluation subjects for the quality assessment. The factors that influenced overall survival were identified. The high-risk group was defined as having at least one of the following: perforation/obstruction, lymph node harvest less than 12, lymphovascular/perineural invasion, positive resection margin, poor differentiation, or pathologic T4 stage.
RESULTS
The median follow-up period was 38 months (range, 1 to 63 months). Chemotherapy was a favorable prognostic factor for either the high- (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.38 to 0.59; p < 0.001) or low-risk group (HR, 0.74; 95% CI, 0.61 to 0.89; p=0.002) in multivariate analysis. This was also the case in patients over 70 years of age. The hazard ratio was significantly increased as the number of involved risk factors was increased in patients who didn't receive chemotherapy. Adding oxaliplatin showed no difference in survival (HR, 1.36; 95% CI, 0.91 to 2.03; p=0.132).
CONCLUSION
Adjuvant chemotherapy can be recommended for stage II colon cancer patients, but the addition of oxaliplatin to the regimen must be selective.

Keyword

Adjuvant chemotherapy; Colonic neoplasms; Treatment outcome

MeSH Terms

Adenocarcinoma
Chemotherapy, Adjuvant*
Colon*
Colonic Neoplasms*
Drug Therapy
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Risk Factors
Treatment Outcome

Figure

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  Fig. 1. Adjusted survival probability curve from multi-variate cox regression analysis of four categories classified according to the risk status and adjuvant chemotherapy (AC) in the whole patients. Survival probability was adjusted for sex, age, body mass index, type of institutions, American Society of Anesthesiologists, and emergency operation. HR, hazard ratio; CI, confidence interval.

• 

  Fig. 2. Adjusted survival curve of stage II colon cancer patients according to the chemotherapy. (A) Low-risk group (adjusted for sex, age, body mass index [BMI], type of institutions, American Society of Anesthesiologists [ASA], and emergency operation). (B) High-risk group (adjusted for number of risk, sex, age, BMI, type of institutions, ASA, and emergency operation). AC, adjuvant chemotherapy; HR, hazard ratio; CI, confidence interval.

Reference

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