Impact of Diabetes Status and Medication on Presentation, Treatment, and Outcome of Stage II Colon Cancer Patients

Diabetes is a risk factor for colorectal cancer and several reports suggest worse cancer-specific outcomes in diabetes patients. Recent studies in multiple tumour types indicate metformin may positively impact on cancer-specific and overall survival. A population-based series of stage II colorectal cancer patients treated and followed from 2000 to 2013 were analysed for baseline characteristics, treatment, and outcomes. 1116 patients with stage II colon cancer were identified, 55.5% were male and median age was 70.9 years (range 20.5–101.2). The diabetes patients (21.6%,n= 241) were older than nondiabetes patients (median 74.0 versus 69.6,p= 0.0001). There was no impact of diabetes on cancer presentation or pathology. Diabetes patients were less likely to receive adjuvant treatment (13.7 versus 24.8%,p= 0.002) but were equally likely to complete treatment (69.7 versus 67.7%,p= 1.00). Diabetes did not significantly impact cancer recurrence (HR = 1.07, 95% CI 0.71–1.63) or overall survival (HR = 1.23, 95% CI 0.88–1.72), adjusted for age. Diabetes medication did not impact cancer recurrence or survival. Cancer presentation and outcomes in diabetes patients are comparable to those of nondiabetes patients in those with stage II colon cancer. The effect of metformin merits further evaluation in patients with colon cancer.

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Association of chemotherapy with survival in stage II colon cancer patients who received radical surgery: a retrospective cohort study

BMC Cancer ◽

10.1186/s12885-021-08057-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhihao Lv ◽

Yuqi Liang ◽

Huaxi Liu ◽

Delong Mo

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Prediction Models ◽

Radical Surgery ◽

Survival Rates ◽

Stage Ii ◽

Survival Prediction ◽

Stage Ii Colon Cancer ◽

Overall Survival Rates

Abstract Background It remains controversial whether patients with Stage II colon cancer would benefit from chemotherapy after radical surgery. This study aims to assess the real effectiveness of chemotherapy in patients with stage II colon cancer undergoing radical surgery and to construct survival prediction models to predict the survival benefits of chemotherapy. Methods Data for stage II colon cancer patients with radical surgery were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (1:1) was performed according to receive or not receive chemotherapy. Competitive risk regression models were used to assess colon cancer cause-specific death (CSD) and non-colon cancer cause-specific death (NCSD). Survival prediction nomograms were constructed to predict overall survival (OS) and colon cancer cause-specific survival (CSS). The predictive abilities of the constructed models were evaluated by the concordance indexes (C-indexes) and calibration curves. Results A total of 25,110 patients were identified, 21.7% received chemotherapy, and 78.3% were without chemotherapy. A total of 10,916 patients were extracted after propensity score matching. The estimated 3-year overall survival rates of chemotherapy were 0.7% higher than non- chemotherapy. The estimated 5-year and 10-year overall survival rates of non-chemotherapy were 1.3 and 2.1% higher than chemotherapy, respectively. Survival prediction models showed good discrimination (the C-indexes between 0.582 and 0.757) and excellent calibration. Conclusions Chemotherapy improves the short-term (43 months) survival benefit of stage II colon cancer patients who received radical surgery. Survival prediction models can be used to predict OS and CSS of patients receiving chemotherapy as well as OS and CSS of patients not receiving chemotherapy and to make individualized treatment recommendations for stage II colon cancer patients who received radical surgery.

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Survival rates for stage II colon cancer patients treated with or without chemotherapy in a population-based setting

International Journal of Colorectal Disease ◽

10.1007/s00384-006-0262-y ◽

2007 ◽

Vol 22 (8) ◽

pp. 887-895 ◽

Cited By ~ 26

Author(s):

Melinda Morris ◽

Cameron Platell ◽

Kieran McCaul ◽

Michael Millward ◽

Guy van Hazel ◽

...

Keyword(s):

Colon Cancer ◽

Cancer Patients ◽

Survival Rates ◽

Population Based ◽

Stage Ii ◽

Stage Ii Colon Cancer

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CHFR methylation as an epigenetic marker for recurrence of colon cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4043 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4043-4043

Author(s):

M. Tanaka ◽

S. Sethi ◽

D. Li ◽

G. Bland ◽

S. R. Hamilton ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Overall Survival ◽

Multivariate Analysis ◽

Cancer Patients ◽

Univariate Analysis ◽

Stage Ii ◽

Rank Test ◽

Tissue Samples ◽

Epigenetic Marker

4043 Background: Currently, no definitive epigenetic markers exist to predict recurrence and overall survival (OS) of colorectal cancer patients after surgical resection. Promoter hypermethylation of the ID4 (inhibitor of DNA binding), RECK (reversion-inducing cysteine rich protein with Kazal motifs), and CHFR (checkpoint with forkhead-associated and RING finger domains) genes have been associated with reduced mRNA and protein expression in colorectal cancer. The purpose of this study was to determine the association of methylation of these genes and also MINT1 (methylated in tumor loci) with recurrence-free survival (RFS) and OS in colon cancer patients. Methods: DNA methylation was quantitatively evaluated using pyrosequencing in tissue samples from 64 patients with AJCC stage II and III colon cancer without HNPCC seen at M.D. Anderson during 1999–2007. Survival outcomes were determined by retrospective chart review and evaluated by Kaplan-Meier plot and log-rank test for univariate analysis and Cox's proportional hazard model for multivariate analysis. Mean methylation rate of multiple CpG sites in the promoter region was used. For this analysis, we defined <15%, 15%-30%, and >30% as methylation-negative, -low, and -high, respectively. Results: There were 19 stage II (30%) and 45 stage III (70%) patients. The median age was 62.1 years (range: 31–86). Adjuvant chemotherapy was completed in 49 patients (77%). After a median follow-up of 54.9 months, 12 (19%) patients developed recurrence and 7 (11%) have died. Methylation of MINT1, ID4, and RECK did not correlate with RFS and OS. The CHFR methylation-high (42%) group had low RFS (P=.04) and OS (P=.03) when compared with the CHFR methylation- negative (38%) and -low (20%) group. CHFR methylation-high was associated with N2 disease (P=.04) and right-sided tumors (P=.002). Multivariate analysis indicated T4 disease [P=.004, HR=8.42 (95% CI: 1.98–35.8)] and CHFR methylation-high [P=.04, HR = 3.79 (95% CI: 1.04–13.8)], were poor prognostic factors for recurrence. Conclusions: The presence of high CHFR promoter methylation correlates with advanced lymph node metastasis and shortened RFS and OS. Methylation of the CHFR promoter is a potential epigenetic marker for colon cancer recurrence and overall survival. No significant financial relationships to disclose.

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Contribution of tumor stroma ratio to a better selection of stage II colon cancer patients into high and low risk groups: A population based study.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.3582 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. 3582-3582

Author(s):

Sanne Kjaer-Frifeldt ◽

Gabi W. van Pelt ◽

Rene dePont Christensen ◽

Wilma E Mesker ◽

Anders Kristian Moeller Jakobsen ◽

...

Keyword(s):

Colon Cancer ◽

Cancer Patients ◽

Tumor Stroma ◽

Risk Groups ◽

Population Based ◽

Low Risk ◽

Stage Ii ◽

Population Based Study ◽

Stage Ii Colon Cancer ◽

Selection Of

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Retrospective analysis of a Bi‐National Colorectal Cancer Audit to characterize stage II colon cancer patients who were offered adjuvant chemotherapy

ANZ Journal of Surgery ◽

10.1111/ans.15735 ◽

2020 ◽

Vol 90 (6) ◽

pp. 1136-1140

Author(s):

Edward A. Cooper ◽

Kenneth N. Buxey ◽

Ben J. Maslen ◽

Mark Muhlmann

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Retrospective Analysis ◽

Cancer Patients ◽

Stage Ii ◽

Stage Ii Colon Cancer

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The prognostic importance of miRNA-21 in stage II colon cancer: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3513 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3513-3513

Author(s):

Sanne Kjaer-Frifeldt ◽

Torben Hansen ◽

Boye Schnack Nielsen ◽

Stine Joergensen ◽

Jan Lindebjerg ◽

...

Keyword(s):

Colon Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Population Based ◽

Stage Ii ◽

Stromal Compartment ◽

Cox Regression Analysis ◽

Prognostic Importance ◽

Stage Ii Colon Cancer

3513 Background: Adjuvant chemotherapy for stage II colon cancer patients is still controversial and the debate on which patients should be considered as high risk patients is still ongoing. The decision is based on clinical and pathological markers of risk, which are inadequately informative in most of the patients, and better methods are highly needed. The aim of the present study was to investigate the possible prognostic importance of miRNA-21, quantified by in situ hybridization (ISH), in a unique, large population-based cohort of patients treated for stage II colon cancer patients. Methods: The study included all patients diagnosed with stage II colon cancer in Denmark in the year 2003 (711 patients), representing a full population of five million people. Patients receiving adjuvant chemotherapy were excluded (N=15). One paraffin-embedded tissue block was obtained from each patient. A 6μm-thick section was processed for formazan-based chromogenic miR-21 ISH analysis and counter stained with nuclear red. The blue miR-21 ISH signal was assessed by image analysis to obtain two quantitative expression estimates: the total blue area (TB) and the ratio of TB with the nuclear density (TBR). Results: The miRNA-21 signal was predominantly observed in fibroblast-like cells located in the stromal compartment of the tumors. Patients expressing high levels of miRNA-21 (high mean TBR) had significantly inferior cancer specific survival (CSS): HR = 1.26 (95% CI; 1.15-1.60), p <0.001. In the COX regression analysis (including; gender, T-category, malignancy grade, localization, tumor perforation, tumor fixation, number of lymph nodes and MSI status), mean TBR was found to be an independent predictive marker of poor CSS, HR = 1.41 (95%CI; 1.19-1.67, p< 0.001). The same applied to TB. Conclusions: The present study shows that increasing miRNA-21 expression level is significantly correlated to decreasing CSS. Analyses of miRNA-21 should be considered as a potential adjunct in the selection of high risk stage II patients.

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