Efficacy of Postoperative Adjuvant Oral Immunochemotherapy in Patients With Dukes' B Colorectal Cancer

Abstract

Among 370 patients who underwent radical resection of primary colorectal cancer over a 17-year period, 167 had stage II-Dukes' B cancer. After excluding 10 patients treated with intravenous drugs other than 5-FU or hepatic arterial injection and 11 patients with rare histological types other than typical differentiated adenocarcinoma, the remaining 146 patients were used to assess the utility of Japanese-style oral postoperative adjuvant immunochemotherapy. Ninety-one patients who received oral chemotherapy with/without immunotherapy as postoperative adjuvant therapy had a 5-year survival rate of 89.1%, while the rate was 66.5% for patients without such therapy (non-chemotherapy; n=55, p=0.0015). When the 91 patients were divided into those treated with chemotherapy plus immunotherapy (immunochemotherapy; n=61) and those treated with chemotherapy alone (chemotherapy-only; n=30), the 5-year survival rates of the immunochemotherapy, chemotherapy-only, and non-chemotherapy groups were 92.2%, 83.5%, and 66.5%, respectively (immunochemotherapy vs. non-chemotherapy, p=0.0022). When 30 patients were selected from each of the 3 groups and compared by the propensity score matching method, a significant difference was found between the immunochemotherapy and chemotherapy-only groups (p=0.0364), as well as between the immunochemotherapy and non-chemotherapy groups (p=0.0055). These results suggest that Japanese-style oral immunochemotherapy is useful as postoperative adjuvant therapy in patients with stage II-Dukes' B colorectal cancer.

Is the T1/2N1 (≤3 nodes) category actually stage IIIA (TNM)/IIIa (Japanese classification) in patients with primary colorectal cancer?

“…this would also reduce the mental burden on patients in the low-risk group and aid in the planning of appropriate follow-up. In patients with stage IIIA/IIIa cancer categorized as t1/2n1 (≤3 nodes), tumor cells may be almost completely eliminated by adjuvant chemotherapy and host antitumor immunity, although single cells or small clusters may continue to circulate in the body (14)(15)(16)(17). It has been reported that a true survival benefit is achieved when there is improvement of survival after recurrence (21)(22)(23).…”

“…In general, stage I patients received surgery and follow-up without postoperative adjuvant therapy (2,3,10), while stage II patients received postoperative adjuvant chemotherapy with oral UFt/psK for 12 months or longer (11)(12)(13). stage III patients received intravenous 5-FU/lV or 5-FU/lV in combination with cpt-11 for 6 months after surgery, and then received oral UFt/Uzel or UFt/ psK for 12 months or longer (14)(15)(16)(17). In principle, surgical resection was chosen as the first-line treatment for postoperative recurrence/metastasis.…”

Predicting recurrence and metastasis of primary esophageal cancer with or without lymph node metastasis

“…However, it is certain that, as in the case of gastric cancer and large bowel cancer, some viable cancer cells including circulating ONCs escape from the primary tumor and are disseminated throughout the body (11,15,17). These malignant cells are generally destroyed after invading peripheral lymphatics or vessels because they are recognized as foreign and phagocytized by host immune cells (20)(21)(22). However, a very small number of cancer cells that escape from the host defenses may reach distant organs such as the liver or lungs and survive there, although the detailed mechanisms involved remain unclear.…”

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

“…In general, Stage II patients received postoperative adjuvant chemotherapy with oral UFT/PSK (Krestin) for 12 months or longer (8)(9)(10). Stage III patients received intravenous 5FU/LV or 5FU/LV in combination with CPT-11 for 6 months after surgery, and then received oral UFT/Uzel (an oral calcium folinate) or UFT/PSK for 12 months or longer (11)(12)(13).…”