Adjuvant Chemotherapy for Stage II Colon Cancer.

Sara Elena Rebuzzi,Guido Pesola,Alberto Felice Sobrero,Valentino Martelli

doi:10.3390/cancers12092584

Sara Elena Rebuzzi, Guido Pesola + Show 2 more

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https://doi.org/10.3390/cancers12092584

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Abstract

Simple SummaryStage II colon cancer is defined as an early stage of the tumor disease, without the involvement of lymph nodes or distant organs. In this group of patients, surgery alone is associated with high cure rate and the role of post-operative chemotherapy is still a matter of debate. In patients with tumor features associated with a high risk of recurrence, post-operative chemotherapy is recommended even if it has a small survival benefit. This clinical issue leads to the need for identifying patients who may benefit from post-operative chemotherapy based on their risk of recurrence. The purpose of this review is to highlight and discuss the uncertainties of the previous trials about the risk stratification, the weight of each prognostic factor and the therapeutic benefit of adjuvant chemotherapy in stage II colon cancer patients. Moreover, we summarize the data from previous studies in a decision algorithm that could help clinicians in clinical practice.In stage II colon cancer management, surgery alone has shown a high cure rate (about 80%), and the role of adjuvant chemotherapy is still a matter of debate. Patients with high-risk features (T4, insufficient nodal sampling, grading, etc.) have a poorer prognosis and, usually, adjuvant chemotherapy is recommended. The purpose of the present study is to highlight and discuss what is still unclear and not completely defined from the previous trials regarding risk stratification and therapeutic benefit of adjuvant chemotherapy. With all the limitations of generalizing, we make the effort of trying to quantify the relative contribution of each prognostic factor and the benefit of adjuvant chemotherapy for stage II colon cancer. Finally, we propose a decision algorithm with the aim of summarizing the current evidence and translating it to clinical practice.

Highlights

IntroductionAdjuvant chemotherapy is the standard of care for stage III colon cancer after surgical resection as it provides an absolute long-term survival benefit between 8.7% and 21.5%, depending upon the T-and
Adjuvant chemotherapy is the standard of care for stage III colon cancer after surgical resection as it provides an absolute long-term survival benefit between 8.7% and 21.5%, depending upon the T-andN-related subclassification (Table 1) [1]
Adjuvant chemotherapy still represents a dilemma in stage II colon cancer patients after complete surgical resection

Summary

Introduction

Adjuvant chemotherapy is the standard of care for stage III colon cancer after surgical resection as it provides an absolute long-term survival benefit between 8.7% and 21.5%, depending upon the T-and. N-related subclassification (Table 1) [1] This survival gain does not hold up in stage II, where surgery alone has a high cure rate and the role of adjuvant chemotherapy with fluoropyrimidines has a small benefit (below 5%) [2]. There is uncertainty over the gain with fluoropyrimidines in overall survival (OS) (0%, 3%, or 5%) This small benefit is due to the fact that most of the stage II patients have a very good long-term survival, leaving a relatively small risk to be reduced by adjuvant therapy [3].

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