CC BY-NC-ND 4.0 · Journal of Coloproctology 2015; 35(04): 203-211
DOI: 10.1016/j.jcol.2015.08.005
Original Article

Assessment of prognosis in patients with stage II colon cancer

Avaliação o prognóstico de pacientes com cancer de colon no estadio II
Patrícia Martins
a  Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
,
Sandra Martins
a  Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
› Author Affiliations

Abstract

Pathologic staging is currently the most important prognostic factor in colon cancer, although individually this procedure does not provide a complete clinical outcome.

This study aimed to determine the disease-specific survival of patients with colon cancer treated in the Braga Hospital from January 2005 to December 2013, according to the American Joint Committee on Cancer, 6th edition, and the disease-free survival and disease-specific survival of high- and low-risk stage II patients, whether in use, or not, of adjuvant chemotherapy.

We obtained a total sample of 578 patients, with 145 and 65 high- and low-risk stage II patients, respectively. We observed a 5-year disease-specific survival rate of 93%, 27.4% and 75% for stage IIA, IIB and IIIA patients, respectively, where IIIA and IIB present statistically significant differences (p = 0.001). In high-risk stage II patients, disease-free survival (p = 0.107) and disease-specific survival (p = 0.037) were higher in the group submitted to chemotherapy. In low- risk patients, disease-free survival was higher in the group submitted to chemotherapy (p = 0.494), while disease-specific survival was lower (p = 0.426).

The differences observed between stage IIB and IIIA survival can be explained by the consensual use of adjuvant chemotherapy in stage IIIA, and by its controversial use in stage IIB. Adjuvant chemotherapy showed to be effective only in high-risk stage II patients in terms of disease-specific survival.

In the future, other markers, namely molecular ones, may be used to stratify the risk of stage II patients and determine who will benefit from adjuvant chemotherapy.

Resumo

O estadiamento patológico é, atualmente, o fator de prognóstico mais importante do câncer de cólon, embora individualmente não preveja totalmente o resultado clínico.

Neste estudo, pretendeu-se determinar a sobrevivência para uma doença específica (SDE) dos pacientes com câncer de cólon tratados no Hospital de Braga entre janeiro de 2005 e dezembro de 2013, de acordo com a 6ª edição da American Joint Committee on Cancer e a Sobrevivência Livre de Doença (SLD) e SDE dos doentes em estadio II, classificados em alto e baixo risco, de acordo com a realização ou não de quimioterapia adjuvante.

Obtivemos uma amostra total de 578 pacientes, dos quais uma parcela pertencia ao estadio II de alto ou de baixo risco (145 e 65 pacientes, respetivamente). Observamos SDE a 5 anos de: 93%, 27,4% e 75% para os estadios IIA, IIB e IIIA, respetivamente; IIIA e IIB apresentaram diferenças significativas (p = 0,001). SLD (p = 0,107) e SDE (p = 0,037) para o estadio II de alto risco foram superiores no grupo tratado com quimioterapia. Nos doentes de baixo risco, SLD foi superior no grupo tratado com quimioterapia (p = 0,494), enquanto que SDE foi inferior (p = 0,426).

As diferenças de sobrevivência observadas para os estadios IIB e IIIA podem se dever ao uso controverso da quimioterapia em IIB e ao uso consensual em IIIA. O uso da quimioterapia adjuvante demonstrou ser efetivo nos doentes em estadio II de alto risco em termos de SDE.

Futuramente, outros marcadores, nomeadamente moleculares, poderão vir a ser utilizados para estratificar o risco do estadio II e definir quem se beneficiará com o tratamento adjuvante.



Publication History

Received: 14 April 2015

Accepted: 28 August 2015

Publication Date:
17 February 2021 (online)

© 2015. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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