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Diseases of the Colon & Rectum

, Volume 44, Issue 11, pp 1682–1688 | Cite as

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

  • G. Burdy
  • Y. Panis
  • A. Alves
  • J. Nemeth
  • A. Lavergne-Slove
  • P. Valleur
Original Contributions

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.

Key words

Colon cancer Adjuvant chemotherapy Tumor recurrence 

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Copyright information

© The American Society of Colon and Rectal Surgeons 2001

Authors and Affiliations

  • G. Burdy
    • 1
  • Y. Panis
    • 1
  • A. Alves
    • 1
  • J. Nemeth
    • 2
  • A. Lavergne-Slove
    • 2
  • P. Valleur
    • 1
  1. 1.From the Department of General SurgeryLariboisiere HospitalFrance
  2. 2.Department of PathologyLariboisiere HospitalFrance

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