Associations of P Score With Real-World Survival Improvement Offered by Adjuvant Chemotherapy in Stage II Colon Cancer: A Large Population-Based Longitudinal Cohort Study

BackgroundBased on a prognostic scoring system (P score) proposed by us recently, this retrospective large population-based and propensity score-matched (PSM) study focused on predicting the survival benefit of adjuvant CT in stage II disease.MethodsPatients diagnosed with stage II colon cancer (N = 73397) were identified from the Surveillance, Epidemiology, and End Results database between January 1, 1988 and December 31, 2005 and divided into the CT and non-CT groups. PSM balanced the patient characteristics between the CT and non-CT groups.ResultsThe magnitude of CSS improvement among patients treated with adjuvant CT was significantly associated with the P score, score 8 [hazard ratio (HR) = 0.580, 95% confidence interval (CI) = 0.323–1.040, P = 0.067] was associated with a much higher increased CSS benefit among patients treated with adjuvant CT as compared to score 2* (*, including scores 0, 1, and 2; HR = 1.338, 95% CI = 1.089–1.644, P = 0.006).ConclusionsHigh P scores were demonstrated to be associated with superior survival benefit of adjuvant CT. Therapy decisions of adjuvant CT in stage II colon cancer could be tailored on the basis of tumor biology, patient characteristics and the P score.

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Circulating tumor DNA guided adjuvant chemotherapy in stage II colon cancer (MEDOCC-CrEATE): study protocol for a trial within a cohort study

BMC Cancer ◽

10.1186/s12885-020-07252-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

S. J. Schraa ◽

◽

K. L. van Rooijen ◽

D. E. W. van der Kruijssen ◽

C. Rubio Alarcón ◽

...

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

Adjuvant Chemotherapy ◽

Study Protocol ◽

Circulating Tumor Dna ◽

Stage Ii ◽

Stage Ii Colon Cancer ◽

Tumor Dna

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Oncologic outcomes after adjuvant chemotherapy with capecitabine compared to 5-fluorouracil/leucovorin for geriatric stage II colon cancer: a retrospective cohort study

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03237-x ◽

2019 ◽

Vol 34 (4) ◽

pp. 629-639

Author(s):

Kil-yong Lee ◽

Ji Won Park ◽

Ki-young Lee ◽

Sangsik Cho ◽

Yoon-Hye Kwon ◽

...

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

Adjuvant Chemotherapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Stage Ii ◽

Oncologic Outcomes ◽

Stage Ii Colon Cancer

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The prognostic value of CD3+ tumor-infiltrating lymphocytes for stage II colon cancer according to use of adjuvant chemotherapy: A large single-institution cohort study

Translational Oncology ◽

10.1016/j.tranon.2020.100973 ◽

2021 ◽

Vol 14 (2) ◽

pp. 100973

Author(s):

Edoardo Francini ◽

Fang-Shu Ou ◽

Stefano Lazzi ◽

Roberto Petrioli ◽

Andrea G. Multari ◽

...

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

Adjuvant Chemotherapy ◽

Prognostic Value ◽

Tumor Infiltrating Lymphocytes ◽

Stage Ii ◽

Single Institution ◽

Stage Ii Colon Cancer ◽

Infiltrating Lymphocytes

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Microsatellite instability and adjuvant chemotherapy in stage II colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.767 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 767-767

Author(s):

Julie L. Koenig ◽

Albert Y. Lin ◽

Erqi L. Pollom ◽

Daniel Tandel Chang

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Microsatellite Instability ◽

Univariate Analysis ◽

Population Based ◽

Stage Ii ◽

Chi Square ◽

Colon Cancers ◽

Multiple Characteristics ◽

Stage Ii Colon Cancer

767 Background: Randomized control trials and population-based studies have not demonstrated a definitive benefit for adjuvant chemotherapy in stage II colon cancers. Tumor side and microsatellite instability (MSI) have been proposed as prognostic and predictive factors, but there is little consensus about their utility. Previous studies have been limited by the availability of MSI data. Because microsatellite stability (MSS) is associated with worse prognosis and higher risk of metastases, we hypothesized patients with MSS would have increased benefit from chemotherapy. Methods: Using the National Cancer Database, we preformed a retrospective cohort study of patients with resected stage II colon cancer diagnosed 2006-2013. Patient and disease characteristics were compared with chi-square tests. Survival was evaluated with Cox proportional hazard models. Results: We identified 59,475 patients with stage II colon cancer. 11.4% of patients had known MSI status (n = 6,763) of which 88% had MSS (n = 5,953) and 12% had MSI (n = 810). Patients with MSS were more likely to receive chemotherapy (28.2% vs 19.9%, p < 0.001) and have left-sided tumors (38.8% vs 16.7%, p < 0.001). MSI (adjusted hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.48-0.87; p = 0.003) and receipt of chemotherapy (HR 0.54, 95% CI 0.42-0.69; p < 0.001) were associated with better survival after controlling for multiple characteristics including tumor side. Although left-sided tumors had better survival on univariate analysis (HR 0.91, 95% CI 0.88-0.94; p < 0.001), side was not an independent predictor of survival after controlling for MSI and other characteristics (HR 1.01, 95% CI 0.86-1.20; p = 0.860). Among patients with MSS, chemotherapy remained associated with improved survival (HR 0.54, 95% CI 0.43-0.70; p < 0.001) and this benefit did not vary by tumor side (interaction p = 0.380). There was no interaction between MSI status and chemotherapy (p = 0.139), but we observed less of a survival benefit for chemotherapy in patients with MSI (HR 0.81, 95% CI 0.38-1.75; p = 0.595). Conclusions: Our data suggest a benefit for adjuvant chemotherapy in stage II colon cancer even after adjusting for MSI status. However, tumor side was not prognostic after controlling for MSI status.

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Adjuvant Chemotherapy for Stage II Colon Cancer With Poor Prognostic Features

Journal of Clinical Oncology ◽

10.1200/jco.2010.34.3426 ◽

2011 ◽

Vol 29 (25) ◽

pp. 3381-3388 ◽

Cited By ~ 254

Author(s):

Erin S. O'Connor ◽

David Yu Greenblatt ◽

Noelle K. LoConte ◽

Ronald E. Gangnon ◽

Jinn-Ing Liou ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Survival Benefit ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Stage Ii ◽

Stage Iii ◽

Prognostic Features ◽

Stage Ii Colon Cancer

Purpose Adjuvant chemotherapy is typically considered for patients with stage II colon cancer characterized by poor prognostic features, including obstruction, perforation, emergent admission, T4 stage, resection of fewer than 12 lymph nodes, and poor histology. Despite frequent use, the survival advantage conferred on patients with stage II disease by chemotherapy is yet unproven. We sought to determine the overall survival benefit of chemotherapy among patients with stage II colon cancer having poor prognostic features. Patients and Methods A total of 43,032 Medicare beneficiaries who underwent colectomy for stage II and III primary colon adenocarcinoma diagnosed from 1992 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) –Medicare database. χ2 and two-way analysis of variance were used to assess differences in patient- and disease-related characteristics. Five-year overall survival was examined using Kaplan-Meier survival analysis and Cox proportional hazards regression with propensity score weighting. Results Of the 24,847 patients with stage II cancer, 75% had one or more poor prognostic features. Adjuvant chemotherapy was received by 20% of patients with stage II disease and 57% of patients with stage III disease. After adjustment, 5-year survival benefit from chemotherapy was observed only for patients with stage III disease (hazard ratio[HR], 0.64; 95% CI, 0.60 to 0.67). No survival benefit was observed for patients with stage II cancer with no poor prognostic features (HR, 1.02; 95% CI, 0.84 to 1.25) or stage II cancer with any poor prognostic features (HR, 1.03; 95% CI, 0.94 to 1.13). Conclusion Among Medicare patients identified with stage II colon cancer, either with or without poor prognostic features, adjuvant chemotherapy did not substantially improve overall survival. This lack of benefit must be considered in treatment decisions for similar older adults with colon cancer.

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The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer: a national population-based cohort study

Oncotarget ◽

10.18632/oncotarget.17767 ◽

2017 ◽

Vol 8 (45) ◽

pp. 80061-80072 ◽

Cited By ~ 6

Author(s):

Young Wan Kim ◽

Eun Hee Choi ◽

Bo Ra Kim ◽

Woo-Ah Ko ◽

Yeong-Mee Do ◽

...

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

Adjuvant Chemotherapy ◽

Population Based ◽

Stage Ii ◽

National Population ◽

The Impact

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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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