Microsatellite Status and Adjuvant Chemotherapy in Patients with Stage II Colon Cancer
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Colon cancers do not represent a homogeneous entity, and the two main known pathways are the microsatellite instability (MSI) and chromosomal instability pathways. Although statistically significant, the absolute improvement in overall survival with 5-fluorouracil (5-FU) adjuvant chemotherapy in patients with stage II colon cancer is small and does not support the use of adjuvant chemotherapy in all patients. Today, concordant and accumulated results of independent large studies show that microsatellite status is a robust prognostic factor in colon cancer. Moreover, patients with stage II MSI tumors do not benefit from 5-FU adjuvant chemotherapy alone. Therefore, these results do not support the use of fluoropyrimidine adjuvant chemotherapy in patients with MSI stage II colon cancer. Consequently, microsatellite status should be determined before making any decision regarding adjuvant chemotherapy in patients with stage II colon cancer.