Identification of Patients with High-risk Lymph Node-negative Colorectal Cancer and Potential Benefit from Adjuvant Chemotherapy

Background: Adjuvant chemotherapy is not indicated in lymph node-negative colorectal adenocarcinoma (CRC), even though some cases will present recurrent disease. It is important to identify a subgroup of patients with the highest risk of relapse because of the potential benefit of adjuvant chemother...

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Published in:Japanese journal of clinical oncology 2004-06, Vol.34 (6), p.323-328
Main Authors: Oñate-Ocaña, Luis F., Montesdeoca, Rene, López-Graniel, Carlos M., Aiello-Crocifoglio, Vincenzo, Mondragón-Sánchez, Ricardo, Cortina-Borja, Mario, Herrera-Goepfert, Roberto, Oros-Ovalle, Cuauhtemoc, Gallardo-Rincón, Dolores
Format: Article
Language:English
Subjects:
Adenocarcinoma - diagnosis
Adenocarcinoma - drug therapy
Adult
Aged
Chemotherapy, Adjuvant - methods
Chemotherapy, Adjuvant - nursing
Cohort Studies
Colorectal Neoplasms - drug therapy
Colorectal Neoplasms - pathology
Female
Humans
Key words: colorectal adenocarcinoma – adjuvant chemotherapy – lymph node-negative – recurrent disease – prognostic factors
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local
Prognosis
Proportional Hazards Models
Retrospective Studies
Time Factors
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Summary:Background: Adjuvant chemotherapy is not indicated in lymph node-negative colorectal adenocarcinoma (CRC), even though some cases will present recurrent disease. It is important to identify a subgroup of patients with the highest risk of relapse because of the potential benefit of adjuvant chemotherapy. The objective of this study is to define the prognostic factors and describe a method for the selection of this subgroup. Methods: A retrospective cohort of 124 patients with lymph node-negative CRC with complete surgical resection was studied. Cox’s proportional hazards model was used to define the prognostic factors associated with CRC-related survival and to develop a method for prediction of recurrence probability. Results: The cohort included 62 women and 62 men with mean age 55.8 years. The mean follow-up period was 11.7 years. T classification of the primary tumor, differentiation grade, carcinoembryonic antigen level, gender and the presence of neural invasion were significant prognostic factors according to the multivariate analysis (final model P = 0.00001). Using risk ratios for these prognostic factors, we defined a high-risk group of 78 patients and a low-risk group of 46 patients with 24 and 5 recurrences, respectively (recurrence rates of 30.8% and 10.9% respectively, P = 0.011). Conclusions: Using these factors, a prognostic scale was developed to predict high risk of recurrence in cases of completely resected CRC and to identify them as a subgroup of patients with potential benefit of adjuvant chemotherapy.
ISSN:0368-2811
1465-3621
DOI:10.1093/jjco/hyh054