Abstract
PurposeTo make a Stage II colorectal cancer (CRC) sub-classification based on clinicopathological factors.MethodsThe subjects of this study were 422 patients with Stage II CRC, who underwent curative surgery with dissection of more than 12 lymph nodes. We used the logistic regression analysis or model and Cox’s proportional hazard regression model for analysis.ResultsPreoperative carcinoembryonic antigen (CEA) level (p = 0.0057), macroscopic type (p = 0.0316), and depth of invasion (p = 0.0401) were extracted as independent risk factors for recurrence, whereas the preoperative CEA level (p = 0.0045) and depth of invasion (p = 0.0395) were extracted as independent predictors of 5-year disease-free survival. We defined depth of invasion (pT4) and the preoperative CEA level (abnormal) as risk factors for recurrence, and classified Grade A as a normal CEA level regardless of depth invasion, Grade B as depth of invasion to pT3 and an elevated CEA level, and Grade C as depth of invasion to pT4 and an elevated CEA level. There were significant differences in cumulative 5-year disease-free survival rates among each grade (Grade A vs. Grade B, p = 0.0474; Grade A vs. Grade C, p < 0.0001; Grade B vs. Grade C, p = 0.0134).ConclusionThe sub-classification of Stage II CRC, according not only to depth of invasion but also to preoperative CEA level, is important for predicting the prognosis.
Highlights
The morbidity associated with colorectal cancer (CRC) is increasing in Japan
For Stage II and Stage III CRC, postoperative adjuvant chemotherapy is integral for managing metastatic recurrence, whereas for Stage 0 and Stage I CRC, successful curative surgery is likely to be achieved
Recurrence rate, age, preoperative carcinoembryonic antigen (CEA) level, macroscopic type, and depth of invasion were extracted by univariate analysis, while preoperative CEA levels, macroscopic type and depth of invasion were the independent factors extracted by multivariate analysis (Table 1)
Summary
Despite advances in chemotherapy and surgical techniques, the recurrence rate increases as the stage of the cancer advances. It has been established that for Stage III CRC, surgery with adjuvant chemotherapy results in a better prognosis than surgery alone [2,3,4]. No consensus has been reached on the effectiveness of adjuvant chemotherapy for Stage II CRC [5]. European and American guidelines suggest selecting those patients at high risk of recurrence and, taking into consideration the risks and benefits, once informed consent for adjuvant chemotherapy after the surgery is obtained, recommend the same treatment and duration as for Stage III CRC [6, 7]. The Japanese guidelines state that since the efficacy of adjuvant chemotherapy for Stage II has not yet been established, it is not
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