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Identifying patients with T3-T4 node-negative colon cancer at high risk of recurrence

  • Original Contributions
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Diseases of the Colon & Rectum

Abstract

PURPOSE: Adjuvant chemotherapy is effective for node-positive colon cancer patients. In node-negative patients, it could be justified in high-risk patients. The purpose of this study was to determine clinical and pathological findings associated with tumor recurrence in T3-T4 node-negative colon cancer patients. METHODS: From 1974 to 1993, 108 patients undergoing colectomy for T3-4N0M0 colon cancer, without adjuvant chemotherapy, followed until death or for a minimum of five years, were divided into two groups: patients without recurrence (n=74) and those dead from colon cancer or alive with recurrence (n=34). Thirty-three clinical and pathological findings were studied. RESULTS: In univariate analysis, the following were significantly associated with a high risk of tumor recurrence: male patients (P=0.006), bowel obstruction (P<0.001), weight loss >5 Kg (P=0.03), circumferential tumor (P=0.02), macroscopic or microscopic pericolic organ invasion (T4 stage;P<0.001), perineural invasion (P=0.02), vascular invasion (P=0.045), poor tumor differentiation (P=0.005), mesocolic invasion>1cm (P=0.009), less than 14 uninvolved nodes on the specimen (P=0.03), and visceral peritoneal invasion (T4;P<0.001). In multivariate analysis, the following were independent prognostic factors of recurrence: male patients (P=0.005), bowel obstruction (P=0.002), pericolic organ invasion (i.e., T4 tumor;P=0.02), and less than 14 uninvolved nodes on a specimen (P=0.01). On the other hand, preoperative carcinoembryonic antigen serum level, size and tumor location, blood transfusion, and mucin production were not associated with higher risk of tumor recurrence. CONCLUSION: Our study identifies a subgroup of patients with node-negative colon cancer at high risk of recurrence, who could be included in priority trials of adjuvant chemotherapy.

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Authors and Affiliations

  1. From the Department of General Surgery, Lariboisiere Hospital, France

    G. Burdy M.D.,  Y. Panis M.D., Ph.D., A. Alves M.D. & P. Valleur M.D.

  2. Department of Pathology, Lariboisiere Hospital, France

    J. Nemeth M.D. & A. Lavergne-Slove M.D.

Authors
  1. G. Burdy M.D.
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  2. Y. Panis M.D., Ph.D.
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  3. A. Alves M.D.
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  4. J. Nemeth M.D.
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  5. A. Lavergne-Slove M.D.
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  6. P. Valleur M.D.
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Burdy, G., Panis, Y., Alves, A. et al. Identifying patients with T3-T4 node-negative colon cancer at high risk of recurrence. Dis Colon Rectum 44, 1682–1688 (2001). https://doi.org/10.1007/BF02234390

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