Adjuvant Therapy in Stage II Colorectal Cancer: A Retrospective Study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".