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Open Access Research article

Predictors of recurrence free survival for patients with stage II and III colon cancer

Vassiliki L Tsikitis13*, David W Larson23, Marianne Huebner23, Christine M Lohse23 and Patricia A Thompson34

Author Affiliations

1 Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA

2 Department of Surgery, The Mayo Clinic, Rochester, Minnesota, 200 First Street SW, 55905 Rochester, MN, USA

3 Department of Health Sciences Research, The Mayo Clinic, Rochester, Minnesota, 200 First Street SW, 55905 Rochester, MN, USA

4 Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, 1333 N. Martin Avenue, 85721 Tucson, Arizona, USA

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BMC Cancer 2014, 14:336  doi:10.1186/1471-2407-14-336

Published: 16 May 2014

Abstract

Background

The aim of this study was to evaluate clinico-pathologic specific predictors of recurrence for stage II/III disease. Improving recurrence prediction for resected stage II/III colon cancer patients could alter surveillance strategies, providing opportunities for more informed use of chemotherapy for high risk individuals.

Methods

871 stage II and 265 stage III patients with colon cancers were included. Features studied included surgery date, age, gender, chemotherapy, tumor location, number of positive lymph nodes, tumor differentiation, and lymphovascular and perineural invasion. Time to recurrence was evaluated, using Cox’s proportional hazards models. The predictive ability of the multivariable models was evaluated using the concordance (c) index.

Results

For stage II cancer patients, estimated recurrence-free survival rates at one, three, five, and seven years following surgery were 98%, 92%, 90%, and 89%. Only T stage was significantly associated with recurrence. Estimated recurrence-free survival rates for stage III patients at one, three, five, and seven years following surgery were 94%, 78%, 70%, and 66%. Higher recurrence rates were seen in patients who didn’t receive chemotherapy (p = 0.023), with a higher number of positive nodes (p < 0.001). The c-index for the stage II model was 0.55 and 0.68 for stage III.

Conclusions

Current clinic-pathologic information is inadequate for prediction of colon cancer recurrence after resection for stage II and IIII patients. Identification and clinical use of molecular markers to identify the earlier stage II and III colon cancer patients at elevated risk of recurrence are needed to improve prognostication of early stage colon cancers.

Keywords:
Chemotherapy; Disease-free survival; Early stage colon cancer; Clinico-pathologic; Predictors of recurrence