Skip to main content

Advertisement

SpringerLink
Log in

Impact of chemotherapy-related prognostic factors on long-term survival in patients with stage III colorectal cancer after curative resection

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

This retrospective study evaluated the prognostic factors of chemotherapy in stage III colorectal cancer after curative resection.

Methods

From 1996 to 2001, 1,054 patients with primary single colorectal cancer underwent curative resection. Seven hundred sixteen patients received various 5-fluorouracil (FU)-based adjuvant chemotherapy regimens, including oral and intravenous treatments. The chemotherapy-related parameters examined included therapeutic duration, frequency, route of administration, composition of combination therapies, and postoperative time interval from the operation to the start of chemotherapy.

Results

The therapeutic duration and postoperative time interval of starting therapy were independent prognostic factors, in addition to clinicopathological factors. The 8-year cancer-specific/overall survival rates in patients who received chemotherapy for >4 months (63.0/58.6%) were significantly higher than the rates in patients who received no chemotherapy (56.7/37.7%, P < 0.01) and those who remained on chemotherapy for 1–4 months (49.4/41.9%, P < 0.05). The 8-year cancer-specific/overall survival rates in patients who waited 1–5 weeks after surgery to receive chemotherapy (62.9/58.5%) were significantly higher versus rates in those who did not receive chemotherapy (56.7/37.7%) and those who did not receive chemotherapy until >5 weeks after surgery (52.3/45.9%) (both P < 0.05). Survival rates did not differ between patients who did not undergo chemotherapy, those for whom chemotherapy lasted 1–4 months, and patients who did not receive chemotherapy until >5 weeks after surgery.

Conclusions

The appropriate duration of therapy and early chemotherapy after surgery were 2 of the most important factors in eradicating occult cancer and effecting long-term survival benefits in patients with stage III colorectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Laurie JA, Moertel CG, Fleming TR et al (1989) Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. The North Central Cancer Treatment Group and the Mayo Clinic. J Clin Oncol 7:1447–1456

    PubMed  CAS  Google Scholar 

  2. Mortel CG, Fleming TR, MacDonald JS et al (1990) Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 322:352–358

    Article  Google Scholar 

  3. Macdonald JS (1999) Adjuvant therapy for colon cancer. CA Cancer J Clin 49:202–219

    Article  PubMed  CAS  Google Scholar 

  4. Chau I, Norman AR, Cunningham D et al (2005) A randomised comparison between 6 months of bolus fluorouracil/leucovorin and 12 weeks of protracted venous infusion fluorouracil as adjuvant treatment in colorectal cancer. Ann Oncol 16:549–557

    Article  PubMed  CAS  Google Scholar 

  5. Neugut AI, Matasar M, Wang X et al (2006) Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol 24:2368–2375

    Article  PubMed  CAS  Google Scholar 

  6. Green FL, Page DL, Fleming IG et al (2002) AJCC cancer staging manual, 6th edn. Springer, New York

    Google Scholar 

  7. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346

    Article  PubMed  CAS  Google Scholar 

  8. Obrand DI, Gordon PH (1997) Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum 40:15–24

    Article  PubMed  CAS  Google Scholar 

  9. Sargent D, Sobrero A, Grothey A et al (2009) Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 27:872–877

    Article  PubMed  Google Scholar 

  10. Tsai WS, Hsieh PS, Yeh CY et al (2011) Long-term survival benefits of adjuvant chemotherapy by decreasing incidence of tumor recurrence without delaying relapse in stage III colorectal cancer. Int J Colorectal Dis 26:1329–1338

    Article  PubMed  Google Scholar 

  11. Glaves D (1983) Correlation between circulating cancer cells and incidence of metastases. Br J Cancer 48:665–673

    Article  PubMed  CAS  Google Scholar 

  12. Sastre J, Maestro ML, Puente J et al. (2008) Circulating tumor cells in colorectal cancer: correlation with clinical and pathological variables. Ann Oncol 19:935–938

    Google Scholar 

  13. Rahbari NN, Aigner M, Thorlund K et al (2010) Meta-analysis shows that detection of circulating tumor cells indicates poor prognosis in patients with colorectal cancer. Gastroenterology 138:1714–1726

    Article  PubMed  Google Scholar 

  14. Allen-March TG, McCullough TK, Patel H et al (2007) Roles of circulating tumor cells in predicting recurrence after excision of primary colorectal carcinoma. Br J Surg 94:96–105

    Article  Google Scholar 

  15. Yih-Huei U, Chien-Yu L, Hsiang-Lin T et al (2008) Persistent presence of postoperative circulating tumor cells is a poor prognostic factor for patients with stage I–III colorectal cancer after curative resection. Ann Surg Oncol 15:2120–2128

    Article  Google Scholar 

  16. Des Guetz G, Uzzan B, Morere JF et al. (2010) Duration of adjuvant chemotherapy for patients with non-metastatic colorectal cancer. Cochrane Database Syst Rev 1. doi:10.1002/14651858

  17. van Servellen G, Chang B, Garcia L et al (2002) Individual and system level factors associated with treatment nonadherence in human immunodeficiency virus-infected men and women. AIDS Patient Care STDS 16:269–281

    Article  PubMed  Google Scholar 

  18. Lacro JP, Dunn LB, Dolder CR et al (2002) Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 63:892–909

    Article  PubMed  Google Scholar 

  19. Perkins DO (2002) Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry 63:1121–1128

    Article  PubMed  Google Scholar 

  20. Thirion P, Michiels S, Pignon JP et al (2004) Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: an updated meta-analysis. J Clin Oncol 22:3766–3775

    Article  PubMed  CAS  Google Scholar 

  21. Haller DG, Catalano PJ, Macdonald JS et al (2005) Phase III study of fluorouracil, leucovorin, and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089. J Clin Oncol 23:8671–8678

    Article  PubMed  Google Scholar 

  22. Chau I, Norman AR, Cunningham D et al (2005) A randomised comparison between 6 months of bolus fuorouracil/leucovorin and 12 weeks of protracted venous infusion fluorouracil as adjuvant treatment in colorectal cancer. Ann Oncol 16:549–557

    Article  PubMed  CAS  Google Scholar 

  23. Poplin EA, Benedetti JK, Estes NC et al (2005) Phase III Southwest Oncology Group 9415/Intergroup 0153 randomized trial of fuorouracil, leucovorin, and levamisole versus fuorouracil continuous infusion and levamisole for adjuvant treatment of stage III and high-risk stage II colon cancer. J Clin Oncol 23:1819–1825

    Article  PubMed  CAS  Google Scholar 

  24. Arkenau HT, Retting K, Porschen R (2005) Adjuvant chemotherapy in curative resected colon carcinoma: 5-fluorouracil/leucovorin versus high-dose 5-fluorouracil 24-h infusion/leucovorin versus high-dose 5-fluorouracil 24-h infusion. Int J Colorectal Dis 20:258–261

    Article  PubMed  CAS  Google Scholar 

  25. Lembersky BC, Wieand HS, Petrelli NJ et al (2006) Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol c-06. J Clin Oncol 24:2059–2064

    Article  PubMed  CAS  Google Scholar 

  26. Twelves C, Wong A, Nowacki MP et al (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352:2696–2704

    Article  PubMed  CAS  Google Scholar 

  27. Dy GK, Krook JE, Green EM et al (2007) Impact of complete response to chemotherapy on overall survival in advanced colorectal cancer: results from Intergroup N9741. J Clin Oncol 25:3469–3474

    Article  PubMed  Google Scholar 

  28. Colucci G, Gebbia V, Paoletti G et al (2005) Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol 23:4866–4875

    Article  PubMed  CAS  Google Scholar 

  29. Saltz LB, Niedzwiecki D, Hollis D et al (2007) Irinotecan fluorouracil plus leucovorin is not superior to fluorouracil plus leucovorin alone as adjuvant treatment for stage III colon cancer: results of CALGB 89803. J Clin Oncol 25:3456–3461

    Article  PubMed  CAS  Google Scholar 

  30. Van Cutsem E, Labianca R, Bodoky G et al (2009) Randomized phase III trial comparing biweekly infusional fluorouracil/leucovorin alone or with irinotecan in the adjuvant treatment of stage III colon cancer PETACC-3. J Clin Oncol 27:3117–3125

    Article  PubMed  Google Scholar 

  31. Ychou M, Raoul JL, Douillard JY (2009) A phase III randomised trial of LV5FU2 + irinotecan versus LV5FU2 alone in adjuvant high-risk colon cancer (FNCLCC Accord02/FFCD9802). Ann Oncol 20:674–680

    Article  PubMed  CAS  Google Scholar 

  32. André T, Boni C, Mounedji-Boudiaf L et al (2004) Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350:23–51

    Article  Google Scholar 

  33. Kuebler JP, Wieand HS, O’Connell MJ et al (2007) Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol 25:2198–2204

    Article  PubMed  CAS  Google Scholar 

  34. Köhne CH, van Cutsem E, Wils J et al (2005) Phase III study of weekly high-dose infusional fluorouracil plus folinic acid with or without irinotecan in patients with metastatic colorectal cancer: European Organisation for Research and Treatment of Cancer Gastrointestinal Group Study 40986. J Clin Oncol 23:4856–4865

    Article  PubMed  Google Scholar 

  35. Brosens RP, Oomen JL, Glas AS et al (2006) POSSUM predicts decreased overall survival in curative resection for colorectal cancer. Dis Colon Rectum 49:825–832

    Article  PubMed  Google Scholar 

  36. Cerottini JP, Caplin S, Pampallona S et al (1999) Prognostic factors in colorectal cancer. Oncol Rep 6:409–414

    PubMed  CAS  Google Scholar 

  37. Rieker RJ, Hammer E, Eisele R et al (2002) The impact of comorbidity on the overall survival and the cause of death in patients after colorectal cancer resection. Arch Surg 387:72–76

    Article  Google Scholar 

  38. Khuri SF, Henderson WG, DePalma RG et al (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:326–341

    PubMed  Google Scholar 

  39. Law WL, Choi HK, Lee YM et al (2007) The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol 14:2559–2566

    Article  PubMed  Google Scholar 

  40. Walker KG, Bell SW, Rickard MJ et al (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240:255–259

    Article  PubMed  Google Scholar 

  41. McArdle CS, McMillan DC, Hole DJ (2005) Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 92:1150–1154

    Article  PubMed  CAS  Google Scholar 

  42. Mynster T, Christensen IJ, Moesgaard F et al (2000) Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group. Br J Surg 87:1553–1562

    Article  PubMed  CAS  Google Scholar 

  43. Bohle B, Pera M, Pascual M et al (2010) Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery 147:120–126

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No author has any conflict of interest.

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing St., Kueishan, Taoyuan, 333, Taiwan

    Wen-Sy Tsai, Pao-Shiu Hsieh, Chien-Yuh Yeh, Jy-Ming Chiang, Reiping Tang, Jinn-Shiun Chen, Chung Rong Changchien & Jeng Yi Wang

  2. Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan

    Wen-Sy Tsai, Pao-Shiu Hsieh, Chien-Yuh Yeh, Jy-Ming Chiang, Reiping Tang, Jinn-Shiun Chen, Chung Rong Changchien & Jeng Yi Wang

Authors
  1. Wen-Sy Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pao-Shiu Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chien-Yuh Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jy-Ming Chiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reiping Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jinn-Shiun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chung Rong Changchien
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jeng Yi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wen-Sy Tsai.

About this article

Cite this article

Tsai, WS., Hsieh, PS., Yeh, CY. et al. Impact of chemotherapy-related prognostic factors on long-term survival in patients with stage III colorectal cancer after curative resection. Int J Clin Oncol 18, 242–253 (2013). https://doi.org/10.1007/s10147-011-0370-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-011-0370-8

Keywords

Search

Navigation