Adjuvant Therapy in Stage II Colorectal Cancer: A Retrospective Study
Notice bibliographique
Résumé
Purpose: The aim of this study was to review our local experience with diagnosis, staging, and treatment of stage II colon cancer, particularly those classified as high-risk disease. Methods: At Centre Hospitalier Universitaire de Sherbrooke, all patients operated for a non-metastatic colon cancer between 2005 and 2012 and identified as pathological stage II according to the AJCC classification 7th version were included in the study. Retrospective analyses were performed on the diagnostic methods, surgery, perioperative complications, pathology results, and adjuvant chemotherapy. Disease-free survival (DFS) and overall survival (OS) were examined with Kaplan-Meier plots. Results: Two hundred (n=200) patients were identified as pathological stage II, 113 of whom were classified as high-risk disease. Clinical staging which included colonoscopy, thoracic, abdominal, and TEP scans were performed in 88%, 91.5%, 82%, and 17.5% of patients, respectively. Post-operative complications occurred in 39% of patients, the most frequent being infectious (leak and/or abscess) in 43.6% and cardiovascular events in 24.4%. Pathological analysis revealed 87.6%, 8.5%, and 4% of stage IIA, IIB, and IIC tumor, respectively. One or more high-risk criteria were identified in 56.5% of patients and were defined as T4 (12.5%), lymphovascular invasion (43%), less than 12 nodes resected (8.5%), perforation (3%), or obstruction (6%) at presentation. Adjuvant treatment was administered to 18.5% of patients, 81.1% of them being considered high risk. The chemotherapy regimens used were FOLFOX in 51.3%, infusional 5-FU/LV in 21.6%, capecitabine in 24.3%, and capecitabine with oxaliplatin in 2.7%. The median delay between surgery and the first chemotherapy treatment was 62 (22, 135) days. The 5-year OS was 77.5% without benefits in patients receiving adjuvant treatment compared with surgery alone (80.5 vs. 76.9%; p=0.31). The 5-year DFS was 73.8% with no difference in the adjuvant therapy group (81.1% vs. 72.2%; p=0.27). Among the high-risk patients, there was a trend in favor of chemotherapy in the 5-year OS (80.9% vs. 67.8%; p=0.08), while there was none in the 5-year DFS (82.3% vs. 66.3%; p=0.12). Our analyses showed that perforation at presentation and T4 tumors were features associated with poorer overall survival. Conclusion: Our local experience shows that adjuvant chemotherapy in patients with stage II colorectal cancer did not significantly improve DFS or OS, but could possibly benefit those with high-risk disease. The applicability of these results is limited by the fact that this is a retrospective study with a limited number of patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».