Adjuvant Therapy for Stage II Colon Cancer: A Systematic Review From the Cancer Care Ontario Program in Evidence-Based Care’s Gastrointestinal Cancer Disease Site Group

Figueredo, A; Charette, Manya; Maroun, J.; Brouwers, Melissa; Zuraw, Lisa

doi:10.1200/jco.2004.03.087

Cited by 310 publications

(205 citation statements)

References 44 publications

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“…[2][3][4][5][6] Currently, adjuvant chemotherapy is an accepted standard of care for patients with stage III colon cancer but is not recommended for the treatment of patients with stage II disease. 7 However, patients with high-risk, lymph node-negative disease, including those with pT4 tumors, may be considered for therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a systematic review of 4187 patients from 37 trials and 11 meta-analyses was performed by the Cancer Care Ontario Program. 5 Their findings included a relative risk of 0.87 that indicated a survival benefit from chemotherapy. Although improved survival was demonstrated in those trials, differences in the length of survival did not reach statistical significance.…”

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confidence: 99%

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Multimarker phenotype predicts adverse survival in patients with lymph node‐negative colorectal cancer

Zlobec

Minoo

Baumhoer

et al. 2007

Cancer

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BACKGROUND. The heterogeneity of stage II colon cancer underlines the need for identifying high‐risk, lymph node‐negative patients. The objective of this study was to define a multimarker prognostic model of 5‐year survival in patients with lymph node‐negative, mismatch repair (MMR)‐proficient colorectal cancer (CRC). METHODS. Immunohistochemistry for 13 tumor markers was performed on 587 lymph node‐negative, MMR‐proficient CRC samples by using a tissue microarray. Immunoreactivity was evaluated semiquantitatively. A receiver‐operating characteristic‐based approach was used to detect clinically relevant tumor markers and to determine cutoff scores for tumor positivity. Univariate and multivariate analyses stratified by pathologic T3 (pT3) or pT4 tumor classification were performed. RESULTS. In univariate analysis, the absence of CD8+ tumor infiltrating lymphocytes (TILs) (P < .001), loss of p27 (P = .006), positive urokinase‐type plasminogen activator (uPA) expression (P = .002), and positive uPA receptor (uPAR) expression (P = .037) were associated with an adverse prognosis. In multivariate analysis, CD8 (P = .001), p27 (P = .031), and uPA (P = .014) were independent prognostic factors. The multimarker phenotype of negative CD8, loss of p27, and positive uPA expression led to significantly worse survival compared with all other combinations of these features. Stratified by pT3 or pT4 stage, CD8 (P = .006) and uPA (P = .011) had independent prognostic value. Combined CD8 negativity and uPA positivity led to a more adverse prognosis in both patients with pT3 tumors and patients with pT4 tumors (P < .001). No difference was observed in the length of survival between patients with pT3 tumors who had CD8 negativity and uPA positivity and patients with pT4 tumors (P = .267). CONCLUSIONS. The multimarker phenotype of the absence of CD8+ TILs, loss of p27, and positive uPA expression was predictive of an adverse prognosis in patients with lymph node‐negative, MMR‐proficient CRC. The current findings suggested that a subgroup of patients with high‐risk, lymph node‐negative pT3 tumors should be considered for adjuvant therapy. Cancer 2008. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Multimarker phenotype predicts adverse survival in patients with lymph node‐negative colorectal cancer

Zlobec

Minoo

Baumhoer

et al. 2007

Cancer

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“…although adjuvant chemotherapy provides a significant survival benefit in stage III patients, whether this treatment has any effect on patients with stage ii colon cancer remains controversial, since 20-30% of these patients eventually experience tumor relapses (2). adjuvant chemotherapy was shown to increase the survival of certain populations of stage ii patients (3). Furthermore, it was found that 60% of stage iii patients did not relapse, even when adjuvant chemotherapy was not used (4).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer

Toiyama

Miki

Inoue

et al. 2010

Experimental and Therapeutic Medicine

105

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Abstract. recent studies have revealed the Glasgow prognostic score (GpS) to aid in the prediction of postoperative outcome in colorectal cancer patients. however, whether GpS predicts poor prognosis in curative colorectal cancer patients has yet to be ascertained. Furthermore, there is no information on the association between GpS and adjuvant chemotherapy in stage ii or iii colorectal cancer patients. a total of 219 patients with stage ii and iii colorectal cancer were included in this trial. The modified GPS (mGPS) defined in this study was calculated on the basis of admission data as follows: patients with an elevated level of both c-reactive protein (0.5 mg/dl) and hypoalbuminemia (alb <3.5 mg/dl) were allocated a score of 2, and patients showing 1 or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. the association between the mGpS and clinicopathological findings and survival was retrospectively assessed. The mGPS was significantly higher in patients with an advanced age, serosal invasion, advanced stage cancer and pre-operative high cEa levels. Kaplan-meier analysis revealed that a higher GpS predicted a higher risk of postoperative mortality in stage ii and/or iii colorectal cancer patients. multivariate analyses revealed that the mGpS was the most sensitive predictor of postoperative mortality in stage ii/iii or stage ii, respectively. the prognosis of stage ii patients with a higher mGpS was as favorable as that of patients with a lower mGpS when adjuvant chemotherapy was undertaken. pre-operative mGpS is considered to be a useful predictor of postoperative mortality in patients with stage ii and/or iii colorectal cancer, independently of the cEa test or tnm system. postoperative adjuvant chemotherapy may be recommended for stage ii colorectal cancer patients with a high mGpS.

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“…4 Adjuvant chemotherapy has been shown to increase survival in certain populations of Stage II patients. 5 Furthermore, almost 60% of Stage III patients do not relapse, even if adjuvant chemotherapy is not given. 6 Therefore, identification of highrisk Stage II and III colorectal cancer patients would be of great benefit in selecting appropriate candidates for standard or intense adjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Vascular Endothelial Growth Factor Levels as a Prognostic Marker for Stage II or III Colorectal Cancer Patients

Kemik

Sümer

et al. 2011

Cancer�Growth�Metastasis

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Background:The aim of the present study was to determine whether serum vascular endothelial growth factor (VEGF) can provide prognostic information independent of carcinoembryonic antigen levels in patients undergoing curative surgery. Methods: Serum samples were collected from 158 patients with colorectal cancer and from 100 controls. Serum and tissue levels of VEGF were measured by enzyme-linked immunosorbent assay. Serum VEGF levels in colorectal cancer patients were compared with those in healthy controls, and we retrospectively assessed the association between serum VEGF levels and clinicopathologic findings and survival. Results: VEGF expression was significantly higher in colorectal cancer tissue compared with nontumor tissue. Mean serum VEGF levels in patients were significantly higher than those in controls, and significantly higher in patients with large tumors, lymph node involvement, and distant metastases. Conclusion: Elevated serum VEGF was significantly associated with poor survival, but was only an independent risk factor for poor survival in Stage II and/or III disease. Elevated serum VEGF is significantly associated with development of colorectal cancer, and lymph or distant invasive phenotypes and survival, especially in Stage II and III patients.

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Adjuvant Therapy for Stage II Colon Cancer: A Systematic Review From the Cancer Care Ontario Program in Evidence-Based Care’s Gastrointestinal Cancer Disease Site Group

Cited by 310 publications

References 44 publications

Multimarker phenotype predicts adverse survival in patients with lymph node‐negative colorectal cancer

Multimarker phenotype predicts adverse survival in patients with lymph node‐negative colorectal cancer

Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer

Preoperative Vascular Endothelial Growth Factor Levels as a Prognostic Marker for Stage II or III Colorectal Cancer Patients

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