Skip to main content

Advertisement

SpringerLink
Log in

Colon Adenocarcinoma Stage IIA—Can We Predict Relapse?

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

To determine prognostic factors for stage IIA colon cancer (CC) recurrence in patients undergoing curative intent surgery without adjuvant treatment.

Methods

Single-centre cohort study. All patients with stage IIA CC discussed in a multidisciplinary colorectal cancer clinic from January 2010 to December 2012 were evaluated. Clinical data, laboratory data and tumour features, including expression of DNA repair proteins (EDRP), were analysed. Assessment of overall and disease free survival, recurrence, recurrence site and recurrence’s method of diagnosis was performed. The associations between variables were tested through the Fisher’s exact test (SPSS 23).

Results

Fifty-five patients were included (55% male gender; mean age at diagnosis was 70.3 years (42–88)). CC was in the left colon in 62%, high grade in 7% and had lymphovascular invasion in 7% of the cases. Only one patient was submitted to emergent surgery for obstructive symptoms. In 55% of cases ≥ 12 lymph nodes were collected. There was EDRP loss in nine patients (MLH1/PMS2: six; MSH2/MSH6: three)—only two fulfilled revised Bethesda criteria. Recurrence occurred in five patients (8.9%), and it was diagnosed through surveillance in all of them. No variable showed a statistically significant association with recurrence; however, there were no recurrences in patients with EPRD loss (p = 0.209). Mean follow-up time was 43 months (2–70). In those with recurrence, mean disease-free survival was 23.4 months.

Conclusions

The overall good prognosis and absence of recurrence predictive factors were confirmed, validating the decision of not to submit stage IIA CC patients to chemotherapy risks.

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. Ait Ouakrim D, Pizot C, Boniol M, et al. Trends in colorectal cancer mortality in Europe: retrospective analysis of the WHO mortality database. BMJ (Clinical research ed). 2015;351:h4970. https://doi.org/10.1136/bmj.h4970.

  2. O’Connor ES, Greenblatt DY, LoConte NK, et al. Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol. 2011;29:3381–8. https://doi.org/10.1200/jco.2010.34.3426.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Akagi Y, Shirouzu K, Kinugasa T. Extramural extension as indicator for postoperative adjuvant chemotherapy in stage IIA (pT3N0) colon cancer. J Surg Oncol. 2013;108:358–63. https://doi.org/10.1002/jso.23407.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Labianca R, Nordlinger B, Beretta GD, Mosconi S, Mandala M, Cervantes A, et al. Early colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24:vi64–72. https://doi.org/10.1093/annonc/mdt354.

    Article  PubMed  Google Scholar 

  5. Saridaki Z, Souglakos J, Georgoulias V. Prognostic and predictive significance of MSI in stages II/III colon cancer. World J Gastroenterol. 2014;20:6809–14. https://doi.org/10.3748/wjg.v20.i22.6809.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Merok M, Ahlquist T, Røyrvik E, et al. Microsatellite instability has a positive prognostic impact on stage II colorectal cancer after complete resection: results from a large, consecutive Norwegian series. Ann Oncol. 2013;24:1274–82. https://doi.org/10.1093/annonc/mds614.

    Article  CAS  PubMed  Google Scholar 

  7. Ribic CM, Sargent DJ, Moore MJ, Thibodeau SN, French AJ, Goldberg RM, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med. 2003;349:247–57. https://doi.org/10.1056/NEJMoa022289.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ramírez-Ramírez MA, Sobrino-Cossío S, de la Mora-Levy JG, et al. Loss of expression of DNA mismatch repair proteins in aberrant crypt foci identified in vivo by magnifying colonoscopy in subjects with hereditary nonpolyposic and sporadic colon rectal cancer. J Gastrointest Cancer. 2013;43:209–14. https://doi.org/10.1007/s12029-011-9303-z.

    Article  Google Scholar 

  9. Lindor NM, Burgart LJ, Leontovich O, Goldberg RM, Cunningham JM, Sargent DJ, et al. Immunohistochemistry versus microsatellite instability testing in phenotyping colorectal tumors. J Clin Oncol. 2002;20:1043–8. https://doi.org/10.1200/JCO.20.4.1043.

    Article  CAS  PubMed  Google Scholar 

  10. Umar A, Boland R, Terdiman J, et al. Revised Bethesda guidelines for hereditary nonpolyposis colorectal cancer (lynch syndrome) and microsatellite instability. J Natl Cancer Inst. 2004;96:261–8.

    Article  CAS  PubMed  Google Scholar 

  11. Benson AB, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004;22:3408–19. https://doi.org/10.1200/JCO.2004.05.063.

    Article  PubMed  Google Scholar 

  12. Verhoeff SR, van Erning FN, Lemmens VE, de Wilt JH, Pruijt JF. Adjuvant chemotherapy is not associated with improved survival for all high risk factors in stage II colon cancer. Int J Cancer. 2016;139:187–93. https://doi.org/10.1002/ijc.30053.

    Article  CAS  PubMed  Google Scholar 

  13. Knijn N, Mogk SC, Teerenstra S, Simmer F, Nagtegaal ID. Perineural invasion is a strong prognostic factor in colorectal cancer: a systematic review. Am J Surg Pathol. 2016;40(1):103–12.

    Article  PubMed  Google Scholar 

  14. Korphaisarn K, Pongpaibul A, Limwongse C, Roothumnong E, Klaisuban W, Nimmannit A, et al. Deficient DNA mismatch repair is associated with favorable prognosis in Thai patients with sporadic colorectal cancer. World J Gastroenterol. 2015;21:926–34. https://doi.org/10.3748/wjg.v21.i3.926.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Benatti P, Gafa R, Barana D, et al. Microsatellite instability and colorectal cancer prognosis. Clin Cancer Res. 2005;11:8332–40. https://doi.org/10.1158/1078-0432.CCR-05-1030.

    Article  CAS  PubMed  Google Scholar 

  16. Samowitz WS, Curtin K, Ma KN, et al. Microsatellite instability in sporadic colon cancer is associated with an improved prognosis at the population level. Cancer Epidemiol Biomark Prev. 2001;10:917–23.

    CAS  Google Scholar 

  17. Popat S, Hubner R, Houlston RS. Systematic review of microsatellite instability and colorectal cancer prognosis. J Clin Oncol. 2005;23:609–18. https://doi.org/10.1200/JCO.2005.01.086.

    Article  CAS  PubMed  Google Scholar 

  18. Lanza G, Gafa R, Santini A, et al. Immunohistochemical test for MLH1 and MSH2 expression predicts clinical outcome in stage II and III colorectal cancer patients. J Clin Oncol. 2006;24:2359–67. https://doi.org/10.1200/JCO.2005.03.2433.

    Article  CAS  PubMed  Google Scholar 

  19. Vilar E, Gruber SB. Microsatellite instability in colorectal cancer-the stable evidence. Nat Rev Clin Oncol. 2010;7:153–62. https://doi.org/10.1038/nrclinonc.2009.237.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sargent DJ, Marsoni S, Monges G, Thibodeau SN, Labianca R, Hamilton SR, et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol. 2010;28:3219–26. https://doi.org/10.1200/JCO.2009.27.1825.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Sinicrope FA, Foster NR, Thibodeau SN, Marsoni S, Monges G, Labianca R, et al. DNA mismatch repair status and colon cancer recurrence and survival in clinical trials of 5-fluorouracil-based adjuvant therapy. J Natl Cancer Inst. 2011;103:863–75. https://doi.org/10.1093/jnci/djr153.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kawakami H, Zaanan A, Sinicrope FA. Microsatellite instability testing and its role in the management of colorectal cancer. Curr Treat Options in Oncol. 2015;16(7):30. https://doi.org/10.1007/s11864-015-0348-2.

    Article  Google Scholar 

  23. Ryana E, Sheahana K, Creavina B, Mohana HM, Winter DC. The current value of determining the mismatch repair status of colorectal cancer: a rationale for routine testing. Crit Rev Oncol Hematol. 2017;116:38–57. https://doi.org/10.1016/j.critrevonc.2017.05.006.

    Article  Google Scholar 

  24. Chang G, Rodriguez-Bigas M, Skibber J, Moyer V. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99:433–41. https://doi.org/10.1093/jnci/djk092.

    Article  PubMed  Google Scholar 

  25. Eveno C, Nemeth J, Soliman H, Praz F, de The H, Valleur P, et al. Association between a high number of isolated lymph nodes in T1 to T4 N0M0 colorectal cancer and the microsatellite instability phenotype. Arch Surg. 2010;145:12–7. https://doi.org/10.1001/archsurg.2009.224.

    Article  CAS  PubMed  Google Scholar 

  26. Belt EJ, te Velde EA, Krijgsman O, et al. High lymph node yield is related to microsatellite instability in colon cancer. Ann Surg Oncol. 2012;19:1222–30. https://doi.org/10.1245/s10434-011-2091-7.

    Article  PubMed  Google Scholar 

  27. Soreide K, Nedrebo BS, Soreide JA, et al. Lymph node harvest in colon cancer: influence of microsatellite instability and proximal tumor location. World J Surg. 2009;33:2695–703. https://doi.org/10.1007/s00268-009-0255-4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal

    João Cortez Pinto, Isadora Rosa, Catarina Martins, Inês Marques, João Pereira da Silva & António Dias Pereira

  2. Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal

    Ricardo Fonseca

  3. Serviço de Oncologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal

    João Freire

Authors
  1. João Cortez Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isadora Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catarina Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inês Marques
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. João Pereira da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ricardo Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. João Freire
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. António Dias Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Isadora Rosa designed the research; João Cortez-Pinto and Catarina Martins performed the research; Isadora Rosa, João Cortez-Pinto and Catarina Martins analysed the data; and Isadora Rosa and João Cortez-Pinto wrote the paper.

Corresponding author

Correspondence to João Cortez Pinto.

Ethics declarations

Institutional Review Board Statement

The study was reviewed and approved for publication by our Institutional Reviewer.

Conflict of Interest

The authors declare that they have no conflict of interest.

Data Sharing Statement

The original anonymous dataset is available on request from the corresponding author at joao_cpinto@hotmail.com.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pinto, J.C., Rosa, I., Martins, C. et al. Colon Adenocarcinoma Stage IIA—Can We Predict Relapse?. J Gastrointest Canc 51, 116–120 (2020). https://doi.org/10.1007/s12029-019-00218-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-019-00218-9

Keywords

Search

Navigation