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

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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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