Postoperative Adjuvant Chemotherapy for Stage II Colorectal Cancer: A Systematic Review of 12 Randomized Controlled Trials
The impact of postoperative adjuvant chemotherapy on the oncological outcomes for stage II colorectal cancer remains controversial.
The literature was searched for studies published between 1985 and 2010 in which patients with stage II colorectal cancer were randomly assigned to receive either surgery combined with postoperative adjuvant chemotherapy or surgery alone. End points included 5-year overall survival, 5-year disease-free survival, recurrence, and mortality.
A significant improvement in 5-year overall survival was associated with surgery combined with postoperative adjuvant chemotherapy for stage II colon cancer (hazard ratio, 0.81; 95% confidence interval (CI), 0.71–0.91) and for stage II rectal cancer (hazard ratio, 0.72; 95% CI, 0.61–0.86). The 5-year disease-free survival also favored the group of surgery combined with postoperative adjuvant chemotherapy for stage II colon cancer (hazard ratio, 0.86; 95% CI, 0.75–0.98) and for stage II rectal cancer (hazard ratio, 0.34; 95% CI, 0.22–0.51). For stage II colon cancer, a significant reduction in risk of recurrence was found in favor of postoperative adjuvant chemotherapy (risk ratio, 0.82; 95% CI, 0.71–0.95).
Postoperative adjuvant chemotherapy for stage II colorectal cancer appears to be associated with improved 5-year overall survival and 5-year disease-free survival, and reduction in risk of recurrence.
KeywordsPostoperative adjuvant chemotherapy Colorectal cancer Stage II
- 2.NCCN Clinical Practice Guidelines in Oncology™. Colon cancer. version 2.2010.Google Scholar
- 3.Benson AB, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, Krzyzanowska MK, Maroun J, McAllister P, Van Cutsem E, Brouwers M, Charette M, Haller DG. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004; 22:3408–19.PubMedCrossRefGoogle Scholar
- 4.Glimelius B, Dahl O, Cedermark B, Jakobsen A, Bentzen SM, Starkhammar H, Grönberg H, Hultborn R, Albertsson M, Påhlman L, Tveit KM; Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Adjuvant chemotherapy in colorectal cancer: a joint analysis of randomised trials by the Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Acta Oncol 2005;44(8):904–912.PubMedCrossRefGoogle Scholar
- 5.Hartung G, Hofheinz RD, Dencausse Y, Sturm J, Kopp-Schneider A, Dietrich G, Fackler-Schwalbe I, Bornbusch D, Gonnermann M, Wojatschek C, Lindemann W, Eschenburg H, Jost K, Edler L, Hochhaus A, Queisser W. Adjuvant therapy with edrecolomab versus observation in stage II colon cancer: a multicenter randomized phase III study. Onkologie 2005;28(6–7):347–350.PubMedCrossRefGoogle Scholar
- 6.Schippinger W, Samonigg H, Schaberl-Moser R, Samonigg H Greil R, Thödtmann R, Tschmelitsch J, Jagoditsch M, Steger GG, Jakesz R, Herbst F, Hofbauer F, Rabl H, Wohlmuth P, Gnant M, Thaler J; Austrian Breast and Colorectal Cancer Study Group. A prospective randomised phase III trial of adjuvant chemotherapy with 5-fluorouracil and leucovorin in patients with stage II colon cancer. Br J Cancer 2007;97(8):1021–1027.PubMedCrossRefGoogle Scholar
- 7.Watanabe M, Kodaira S, Takahashi T, Tominaga T, Hojo K, Kato T, Kunitomo K, Isomoto H, Ohashi Y, Yasutomi M. Randomized trial of the efficacy of adjuvant chemotherapy for colon cancer with combination therapy incorporating the oral pyrimidine 1-hexylcarbamoyl-5-fluorouracil. Langenbecks Arch Surg 2006;391(4):330–337.PubMedCrossRefGoogle Scholar
- 12.Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R; German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731–1740.PubMedCrossRefGoogle Scholar
- 19.Light R J, Pillemer D B. Quantitative procedures. The Science of Reviewing Research, 1984.Google Scholar
- 20.Kato T, Ohashi Y, Nakazato H, Koike A, Saji S, Suzuki H, Takagi H, Nimura Y, Hasumi A, Baba S, Manabe T, Maruta M, Miura K, Yamaguchi A. Efficacy of oral UFT as adjuvant chemotherapy to curative resection of colorectal cancer: multicenter prospective randomized trial. Langenbecks Arch Surg 2002;386(8):575–581.PubMedCrossRefGoogle Scholar
- 22.Wolmark N, Rockette H, Wickerham DL, Fisher B, Redmond C, Fisher ER, Potvin M, Davies RJ, Jones J, Robidoux A, et al. Adjuvant therapy of Dukes’ A, B, and C adenocarcinoma of the colon with portal-vein fluorouracil hepatic infusion: preliminary results of National Surgical Adjuvant Breast and Bowel Project Protocol C-02. J Clin Oncol 1990;8(9):1466–1475.PubMedGoogle Scholar
- 23.Zaniboni A, Labianca R, Marsoni S, Torri V, Mosconi P, Grilli R, Apolone G, Cifani S, Tinazzi A. GIVIO-SITAC 01: A randomized trial of adjuvant 5-fluorouracil and folinic acid administered to patients with colon carcinoma-long term results and evaluation of the indicators of health-related quality of life. Cancer 1998;82(11):2135–2144.PubMedCrossRefGoogle Scholar
- 25.The Colorectal Cancer Chemotherapy Study Group of Japan. Five-year results of a randomized controlled trial of adjuvant chemotherapy for curatively resected colorectal carcinoma. Jpn J Clin Oncol 1995;25(3):91–103.Google Scholar
- 26.Watanabe M, Nishida O, Kunii Y, Kodaira S, Takahashi T, Tominaga T, Hojyo K, Kato T, Niimoto M, Kunitomo K, Isomoto H, Ohashi Y, Yasutomi M. Randomized controlled trial of the efficacy of adjuvant immunochemotherapy and adjuvant chemotherapy for colorectal cancer, using different combinations of the intracutaneous streptococcal preparation OK-432 and the oral pyrimidines 1-hexylcarbamoyl-5-fluorouracil and uracil/tegafur. Int J Clin Oncol 2004;9(2):98–106.PubMedCrossRefGoogle Scholar
- 27.Smith DE, Muff NS, Shetabi H, Stutz FH, Eiesland H. Postoperative adjuvant chemotherapy and radiotherapy for cancer of the large bowel and rectum. Am J Surg 1989;157(5):508–11Google Scholar