Ann Surg Treat Res.  2022 May;102(5):271-280. 10.4174/astr.2022.102.5.271.

Effectiveness of oral fluoropyrimidine monotherapy as adjuvant chemotherapy for high-risk stage II colon cancer

• Cho JR
• Lee KW
• Oh HK
• Kim JW
• Kim JW
• Kim DW
• Kim JH
• Kang SB

• KMID: 2529681
• DOI: http://doi.org/10.4174/astr.2022.102.5.271

Abstract

Purpose
The benefit of adjuvant chemotherapy for stage II colon cancer has not been clearly demonstrated even in cases with high-risk factors. This study aimed to compare the effectiveness of oral fluoropyrimidine monotherapy as adjuvant chemotherapy with that of intravenous fluoropyrimidine-based chemotherapy for high-risk stage II colon cancer.
Methods
This single-institution, retrospective study included patients who underwent curative resection for high-risk stage II colon cancer between 2003 and 2014. Patients were classified into 3 postoperative treatment groups: observation, oral fluoropyrimidine monotherapy group (OG), or intravenous fluoropyrimidine-based chemotherapy group (IVG).
Results
We identified 356 patients, including 87 (24.4%) in the observation group, 172 (48.3%) in the OG, and 97 (27.2%) in the IVG. Patients in the OG were older (63.8 ± 10.7 vs. 56.5 ± 10.8, P < 0.001) and had a lower number of T4 lesions (12.8% vs. 35.1%, P < 0.001) than those in the IVG. Regarding survival outcomes, the 5-year overall and disease-free survival rates were not different between the OG and IVG (91.2% vs. 92.6% [P = 0.090] and 85.1% vs. 81.9% [P = 0.535], respectively). In multivariate analysis, age over 70 years and no adjuvant chemotherapy were associated with poor overall survival and disease-free survival. Fewer chemotherapy-related adverse events of grade ≥3 were observed in the OG than in the IVG (12.2% vs. 34.0%, P < 0.001).
Conclusion
In high-risk stage II colon cancer, adjuvant oral fluoropyrimidine monotherapy can be an effective and convenient alternative to intravenous fluoropyrimidine-based chemotherapy as it has comparable oncological outcomes and reduced chemotherapy-related complications.

Keyword

Adjuvnat chemotherapy; Capecitabine; Colonic neoplasms

Figure

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  Fig. 1 Flowchart depicting the patient selection criteria. MSI-H, high-frequency microsatellite instability; IV, intravenous; UFT, tegafur/uracil; FL, 5-fluorouracil/leucovorin; FOLFOX, FL with oxaliplatin.

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  Fig. 2 Analysis of survival (Kaplan-Meier) according to the postoperative management for high-risk stage II colon cancer. (A) Overall survival (OS) and (B) disease-free survival (DFS). IV, intravenous.

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  Fig. 3 Analysis of survival (Kaplan-Meier) with the inclusion of oxaliplatin as part of adjuvant chemotherapy for high-risk stage II colon cancer. (A) Overall survival (OS) and (B) disease-free survival (DFS).

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