Stratification of Stage III colon cancer may identify a patient group not requiring adjuvant chemotherapy

Abstract

Purpose Adjuvant chemotherapy for colon cancer with lymph node involvement (Stage III) has been the standard of care since the 1990s. Meanwhile, considerable evolvement of surgery combined with dedicated histopathological examinations may have led to stage migration. Furthermore, prognostic factors other than lymph node involvement have proven to affect overall survival. Thus, adjuvant chemotherapy in Stage III colon cancer should be reconsidered. The objective was to compare recurrence rates and survival in stage III colon cancer patients treated with or without adjuvant chemotherapy. Further, to assess the impact of extensive mesenterectomy, lymph node stage and vascular invasion on outcome. Methods Consecutive patients operated for Stage III colon carcinoma between 31 December 2005 and 31 December 2015 were identified in the pathological code register by matching colon (T67) and either adenocarcinoma (M81403) or mucinous adenocarcinoma (M84803), with lymph node (T08) and metastasis of adenocarcinoma (M81406 or M84806). Medical records of all identified patients were reviewed. Results Of 216 identified patients, 69 received no postoperative adjuvant chemotherapy (group NC), 69 insufficient adjuvant chemotherapy (FLV or < minimum recommended 6 cycles FLOX, group IC), and 78 sufficient adjuvant chemotherapy (≥ 6 cycles FLOX, group SC). When adjusted for age and comorbidity, 5-year overall survival did not differ statistically significant between groups (76% vs. 83% vs. 85%, respectively). Vascular invasion and a high lymph node ratio significantly reduced overall survival. Conclusion The findings imply that subgroups of Stage III colon cancer patients have good prognosis also without adjuvant chemotherapy. For definite conclusions about necessity of adjuvant chemotherapy, prospective trials are needed.

More Than Lymph Node Dissection Has an Effect on Overall Survival For Right Colon Cancer

“…We are impressed with the work presented by Zhou et al 1 Some recent retrospective publications have stated similar results, namely that time to recurrence was significantly longer after more extensive lymph node dissection (D3) than after less extensive lymph node dissection 2 ; however, the extent of lymph node dissection alone did not have a significant impact on 5-year overall survival. Moreover, it was noticed that vascular invasion and a high lymph node ratio significantly reduced the overall survival.…”

Interactions of occult tumor spread and surgical technique on overall and disease-free survival in patients operated for stage I and II right-sided colon cancer

“…When considering the correlation between 5YDFS and 5YOS, and numbers of harvested lymph nodes speculation can be made that a proportion of patients have local MRD after surgery. This study shows a higher harvest of lymph nodes in the ML group (26) (Spasojevic et al 2013 ; Malik et al 2020 ; Nesgaard et al 2015 ) in comparison to the LM group (15) while a non-significant, but the nevertheless lower local recurrence rate is noted in the group where a higher lymph node harvest was registered. Most studies have shown MM/ITC detection around 30% in stage I/II, which is the nearly the same proportion as in our study.…”

“…The underlying reason for this high variability can lie in the methodology used to verify the cells but can also be dependent on the specimen mobilization technique deployed at surgery. Furthermore, studies, where results are stratified according to colon segments are scarce, when known that lymph node numbers for different colon segments can differ significantly (Trepanier et al 2019 ; Hohenberger et al 2009 ; Malik et al 2020 ). Unfortunately, most publications include the right, left colon as well as rectum and fail to report the mode of access or specimen mobilization technique.…”

Chemotherapy reduces long‐term quality of life in recurrence‐free colon cancer survivors (LaTE study)—a nationwide inverse probability of treatment‐weighted registry‐based cohort study and survey

“…For SCIN a statistically significant difference was found between the two groups for the items SCIN 1-4 (paraesthesia, numbness and coldness of hands and feet; p < 0.001) and no significant difference for item SCIN 5 (tinnitus; p = 0.102) and SCIN 6 (hearing loss; p = 0.173) (Figure 3). LARS score, when divided into major (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42), minor (21)(22)(23)(24)(25)(26)(27)(28)(29) and no (0-20) LARS, did not differ significantly (p = 0.667) between the two groups (Table S2).…”