Cancer Research and Treatment

Original Articles

Effect of Adjuvant Chemotherapy on Stage II Colon Cancer: Analysis of Korean National Data: Min Ki Kim, Daeyoun David Won, Sun Min Park, Taejung Kim, Sung Ryong Kim, Seong Taek Oh, Seung Kook Sohn, Mi Yeon Kang, In Kyu Lee; Cancer Res Treat. 2018;50(4):1149-1163. Published online December 7, 2017; DOI: https://doi.org/10.4143/crt.2017.194

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Purpose
Debates exist regarding the effectiveness of adjuvant chemotherapy for stage II colon cancer. This study aimed to investigate the current status of adjuvant chemotherapy and its impact on survival for Korean stage II colon cancer patients by analyzing the National Quality Assessment data.
Materials and Methods
A total of 7,880 patientswho underwent curative resection for stage II colon adenocarcinoma between January 2011 andDecember 2014 in Koreawere selected randomly as evaluation subjects for the quality assessment. The factors that influenced overall survival were identified. The high-risk group was defined as having at least one of the following: perforation/ obstruction, lymph node harvest less than 12, lymphovascular/perineural invasion, positive resection margin, poor differentiation, or pathologic T4 stage.
Results
The median follow-up period was 38 months (range, 1 to 63 months). Chemotherapy was a favorable prognostic factor for either the high- (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.38 to 0.59; p < 0.001) or low-risk group (HR, 0.74; 95% CI, 0.61 to 0.89; p=0.002) in multivariate analysis. This was also the case in patients over 70 years of age. The hazard ratio was significantly increased as the number of involved risk factors was increased in patients who didn’t receive chemotherapy. Adding oxaliplatin showed no difference in survival (HR, 1.36; 95% CI, 0.91 to 2.03; p=0.132).
Conclusion
Adjuvant chemotherapy can be recommended for stage II colon cancer patients, but the addition of oxaliplatin to the regimen must be selective.

Citations

Citations to this article as recorded by

Colon cancer: the 2023 Korean clinical practice guidelines for diagnosis and treatment
Hyo Seon Ryu, Hyun Jung Kim, Woong Bae Ji, Byung Chang Kim, Ji Hun Kim, Sung Kyung Moon, Sung Il Kang, Han Deok Kwak, Eun Sun Kim, Chang Hyun Kim, Tae Hyung Kim, Gyoung Tae Noh, Byung-Soo Park, Hyeung-Min Park, Jeong Mo Bae, Jung Hoon Bae, Ni Eun Seo, Cha
Annals of Coloproctology.2024; 40(2): 89. CrossRef
Factors Affecting Recurrence and Survival in Stage IIA Colon Cancer Patients
Mert Erciyestepe, Oğuzhan Selvi, Gülhan Dinç, Ahmet Emin Öztürk, Okan Aydın, Şermin Dinç Sonuşen, Tuğçe Kübra Güneş, Tugay Avcı, Sezai Vatansever, Emir Çelik, Muhammed Mustafa Atcı
Oncology.2024; 102(12): 1009. CrossRef
Postoperative chemotherapy use and survival in non-high-risk young and high-risk old-aged patients with stage II colon cancer
Tian Jin, Yingshuang Zhu, Wei Lu, Chenqin Le, Lijuan Wang, Qian Xiao, Kefeng Ding
Holistic Integrative Oncology.2023;[Epub] CrossRef
Risk factors for recurrence in elderly patients with stage II colorectal cancer: a multicenter retrospective study
Takuki Yagyu, Manabu Yamamoto, Akimitsu Tanio, Kazushi Hara, Ken Sugezawa, Chihiro Uejima, Kyoichi Kihara, Shigeru Tatebe, Yasuro Kurisu, Shunsuke Shibata, Toshio Yamamoto, Hiroshi Nishie, Setsujo Shiota, Hiroaki Saito, Takuji Naka, Kenji Sugamura, Kuniyu
BMC Cancer.2022;[Epub] CrossRef
The role of high-risk features in stage II colon cancer after surgical treatment
Patricio Bernardo Lynn, Garrett Yoon, Terry Li, Meng Cao, Michael Grieco, H. Leon Pachter, Russell C. Langan, Patrick Hilden, Joanna Sesti, Jason Maggi
Surgery Open Digestive Advance.2022; 7: 100054. CrossRef
Survival impact of adjuvant chemotherapy in patients with stage IIA colon cancer: Analysis of the National Cancer Database
Pietro Achilli, Jacopo Crippa, Fabian Grass, Kellie L. Mathis, Anne‐Lise D. D'Angelo, Mohamed A. Abd El Aziz, Courtney N. Day, William S. Harmsen, David W. Larson
International Journal of Cancer.2021; 148(1): 161. CrossRef
Associations of P Score With Real-World Survival Improvement Offered by Adjuvant Chemotherapy in Stage II Colon Cancer: A Large Population-Based Longitudinal Cohort Study
Qi Liu, Zezhi Shan, Dakui Luo, Sheng Zhang, Qingguo Li, Xinxiang Li
Frontiers in Oncology.2021;[Epub] CrossRef
Impact of Inadequate Number of Lymph Nodes Examined on Survival in Stage II Colon Cancer
Qi Wu, Zhiyuan Zhang, Yijiao Chen, Jiang Chang, Yudong Jiang, Dexiang Zhu, Ye Wei
Frontiers in Oncology.2021;[Epub] CrossRef
Effect of Adjuvant Chemotherapy on Elderly Stage II High-Risk Colorectal Cancer Patients
Yujin Lee, Inseok Park, Hyunjin Cho, Geumhee Gwak, Keunho Yang, Byung-Noe Bae
Annals of Coloproctology.2021; 37(5): 298. CrossRef
Elderly High-Risk Stage II Colorectal Cancer Patients: Candidates for Improving Outcome?
Min Ki Kim
Annals of Coloproctology.2021; 37(5): 267. CrossRef
Efficacy and tolerability of adjuvant therapy in ≥70-year-old patients with T3N0M0 colorectal cancer: An observational study
Abdullah Sakin, Nurgul Yasar, Suleyman Sahin, Serdar Arici, Saban Secmeler, Orcun Can, Caglayan Geredeli, Cumhur Demir, Sener Cihan
Journal of Oncology Pharmacy Practice.2020; 26(3): 619. CrossRef
Postoperative chemotherapy improves survival in patients with resected high‐risk Stage II colorectal cancer: results of a systematic review and meta‐analysis
C. Simillis, H. K. S. I. Singh, T. Afxentiou, S. Mills, O. J. Warren, J. J. Smith, P. Riddle, M. Adamina, D. Cunningham, P. P. Tekkis
Colorectal Disease.2020; 22(10): 1231. CrossRef
Patient Selection for Adjuvant Chemotherapy in High-Risk Stage II Colon Cancer
Chao Zhang, Songcheng Yin, Yuen Tan, Jinyu Huang, Pengliang Wang, Wenbin Hou, Zhe Zhang, Huimian Xu
American Journal of Clinical Oncology.2020; 43(4): 279. CrossRef
Mucinous Histology Might Be an Indicator for Enhanced Survival Benefit of Chemotherapy in Stage II Colon Cancer
Yong Huang, Kuanxue Ge, Guangshun Fu, Junfeng Chu, Wei Wei
Frontiers in Medicine.2020;[Epub] CrossRef
Re-Evaluation of the Survival Paradox Between Stage IIB/IIC and Stage IIIA Colon Cancer
Hongbo Li, Guangshun Fu, Wei Wei, Yong Huang, Zhenguang Wang, Tao Liang, Shuyun Tian, Honggang Chen, Wei Zhang
Frontiers in Oncology.2020;[Epub] CrossRef
Evaluating the Guiding Role of Elevated Pretreatment Serum Carcinoembryonic Antigen Levels for Adjuvant Chemotherapy in Stage IIA Colon Cancer: A Large Population-Based and Propensity Score-Matched Study
Qi Liu, Yongqiang Huang, Dakui Luo, Sheng Zhang, Sanjun Cai, Qingguo Li, Yanlei Ma, Xinxiang Li
Frontiers in Oncology.2019;[Epub] CrossRef
Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer
Kil-yong Lee, Ji Won Park, Ki-young Lee, Sangsik Cho, Yoon-Hye Kwon, Min Jung Kim, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park
Scientific Reports.2019;[Epub] CrossRef
The use of chemotherapy in older patients with stage II and III colon cancer: Variation by age and era of diagnosis
Susan L. Green, David E. Dawe, Zoann Nugent, Winson Y. Cheung, Piotr M. Czaykowski
Journal of Geriatric Oncology.2018;[Epub] CrossRef

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The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma: Sea-Won Lee, Jong Hoon Lee, In Kyu Lee, Seong Taek Oh, Dae Yong Kim, Tae Hyun Kim, Jae Hwan Oh, Ji Yeon Baek, Hee Jin Chang, Hee Chul Park, Hee Cheol Kim, Eui Kyu Chie, Taek-Keun Nam, Hong Seok Jang; Cancer Res Treat. 2018;50(3):1039-1050. Published online November 21, 2017; DOI: https://doi.org/10.4143/crt.2017.252

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Purpose
A pooled analysis of multi-institutional trials was performed to analyze the effect of surgical timing on tumor response by comparing short course concurrent chemoradiotherapy (CCRT) with long course CCRT followed by delayed surgery in locally advanced rectal cancer.
Materials and Methods
Three hundred patients with cT3-4N0-2 rectal adenocarcinoma were included. Long course patients from KROG 14-12 (n=150) were matched 1:1 to 150 short course patients from KROG 10-01 (NCT01129700) and KROG 11-02 (NCT01431599) according to stage, age, and other risk factors. The primary endpoint was to determine the interval between surgery and the last day of neoadjuvant CCRT which yields the best tumor response after the short course and long course CCRT. Downstaging was defined as ypT0-2N0M0 and pathologic complete response (ypCR) was defined as ypT0N0M0, respectively.
Results
Both the long and short course groups achieved lowest downstaging rates at < 6 weeks (long 20% vs. short 8%) and highest downstaging rates at 6-7 weeks (long 44% vs. short 40%). The ypCR rates were lowest at < 6 weeks (both long and short 0%) and highest at 6-7 weeks (long 21% vs. short 11%) in both the short and long course arms. The downstaging and ypCR rates of long course group gradually declined after the peak at 6-7 weeks and those of the short course group trend to constantly increase afterwards.
Conclusion
It is optimal to perform surgery at least 6 weeks after both the short course and long course CCRT to obtain maximal tumor regression in locally advanced rectal adenocarcinoma.

Citations

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Pathologic complete response after neoadjuvant therapy for locally advanced rectal cancer in a real-world setting: a population-based study
Lina Cadili, Jonathan M. Loree, Michael Peacock, Kimberly DeVries, Amandeep Ghuman, Ahmer A. Karimuddin, P. Terry Phang, Manoj J. Raval, Carl J. Brown
Frontiers in Oncology.2025;[Epub] CrossRef
Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery
Ting‐Yu Chiang, Yu‐Jen Hsu, Yih‐Jong Chern, Chun‐Kai Liao, Wen‐Sy Tsai, Pao‐Shiu Hsieh, Hung‐Chih Hsu, Yu‐Fen Lin, Hsiu‐Lan Lee, Jeng‐Fu You
Cancer Medicine.2024;[Epub] CrossRef
Lateral Lymph Node Size and Tumor Distance From Anal Verge Accurately Predict Positive Lateral Pelvic Lymph Nodes in Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Diseases of the Colon & Rectum.2023; 66(6): 785. CrossRef
Robotic Lateral Pelvic Lymph Node Dissection Could Harvest More Lateral Pelvic Lymph Nodes over Laparoscopic Approach for Mid-to-Low Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ri Na Yoo, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Biomedicines.2023; 11(6): 1556. CrossRef
Does a long interval between neoadjuvant chemoradiotherapy and surgery benefit the clinical outcomes of locally advanced rectal cancer? A systematic review and meta analyses
Miao Yu, Deng-Chao Wang, Sheng Li, Li-Yan Huang, Jian Wei
International Journal of Colorectal Disease.2022; 37(4): 855. CrossRef
Predicting Factors of Complete Pathological Response in Locally Advanced Rectal Cancer
AmirHossein Latif, Mohammad Shirkhoda, Mohammad Reza Rouhollahi, Saeed Nemati, Seyed Hossein Yahyazadeh, Kazem Zendehdel, Ahmad Reza Soroush, Aidin Yaghoobi Notash
Middle East Journal of Digestive Diseases.2022; 14(4): 443. CrossRef
Practical recommendation for treatment of patients with colon cancer during covid-19 pandemic
M. Yu. Fedyanin
Meditsinskiy sovet = Medical Council.2020; (9): 213. CrossRef
Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer
É J Ryan, D P O'Sullivan, M E Kelly, A Z Syed, P C Neary, P R O'Connell, D O Kavanagh, D C Winter, J M O'Riordan
British Journal of Surgery.2019; 106(10): 1298. CrossRef
Preoperative short-course radiotherapy (5 × 5 Gy) with delayed surgery versus preoperative long-course radiotherapy for locally resectable rectal cancer: a meta-analysis
Wang Qiaoli, Huang Yongping, Xiong Wei, Xu Guoqiang, Ju Yunhe, Liu Qiuyan, Li Cheng, Guo Mengling, Li Jiayi, Xiong Wei, Yang Yi
International Journal of Colorectal Disease.2019; 34(12): 2171. CrossRef
Comparison of long course and short course preoperative radiotherapy in the treatment of locally advanced rectal cancer: a systematic review and meta-analysis
Yongjun Yu, Yuwei Li, Chen Xu, Zhao Zhang, Xipeng Zhang
Revista Española de Enfermedades Digestivas.2018;[Epub] CrossRef

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Novel Methods of Lymph Node Evaluation for Predicting the Prognosis of Colorectal Cancer Patients with Inadequate Lymph Node Harvest: Taek Soo Kwon, Sung Bong Choi, Yoon Suk Lee, Jun-Gi Kim, Seong Taek Oh, In Kyu Lee; Cancer Res Treat. 2016;48(1):216-224. Published online April 15, 2015; DOI: https://doi.org/10.4143/crt.2014.312

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Purpose
Lymph node metastasis is an important factor for predicting the prognosis of colorectal cancer patients. However, approximately 60% of patients do not receive adequate lymph node evaluation (less than 12 lymph nodes). In this study, we identified a more effective tool for predicting the prognosis of patients who received inadequate lymph node evaluation.
Materials and Methods
The number of metastatic lymph nodes, total number of lymph nodes examined, number of negative metastatic lymph nodes (NL), lymph node ratio (LR), and the number of apical lymph nodes (APL) were examined, and the prognostic impact of these parameters was examined in patients with colorectal cancer who underwent surgery from January 2004 to December 2011. In total, 806 people were analyzed retrospectively.
Results
In comparison of different lymph node analysis methods for rectal cancer patients who did not receive adequate lymph node dissection, the LR showed a significant difference in overall survival (OS) and the APL predicted a significant difference in disease-free survival (DFS). In the case of colon cancer patients who did not receive adequate lymph node dissection, LR predicted a significant difference in DFS and OS, and the APL predicted a significant difference in DFS.
Conclusion
If patients did not receive adequate lymph node evaluation, the LR and NL were useful parameters to complement N stage for predicting OS in colon cancer, whereas LR was complementary for rectal cancer. The APL could be used for prediction of DFS in all patients.

Citations

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Machine learning based predictive model and genetic mutation landscape for high-grade colorectal neuroendocrine carcinoma: a SEER database analysis with external validation
Ruixin Wu, Sihao Chen, Yi He, Ya Li, Song Mu, Aishun Jin
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Min Xie, Yi Zhang, Xinyang Li, Jiayue Li, Xingyu Zou, Yiji Mao, Haixian Zhang, Subrata Kumar Sarker
International Journal of Intelligent Systems.2024;[Epub] CrossRef
Rectal Cancer: Are 12 Lymph Nodes the Limit?
Paweł Mroczkowski, Łukasz Dziki, Tereza Vosikova, Ronny Otto, Anna Merecz-Sadowska, Radosław Zajdel, Karolina Zajdel, Hans Lippert, Olof Jannasch
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Hui-Long Guo, Jing-Yao Chen, You-Zhen Tang, Qian-Lin Zeng, Qing-Long Jian, Ming-Zhe Li, Yu-Long He, Wen-Hui Wu
International Journal of Surgery.2023;[Epub] CrossRef
Construction of a Prognostic Nomogram for Colorectal Cancer Patients with Fewer than Twelve Lymph Nodes Examined: a Population-Based Study in the SEER Database and China
Hao Zhang, Hanqing Hu, Zilong Guan, Rui Chen, Chao Xu, Rui Huang, Guiyu Wang
Journal of Gastrointestinal Surgery.2022; 26(1): 214. CrossRef
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Hao Zhang, Chunlin Wang, Yunxiao Liu, Hanqing Hu, Guiyu Wang
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Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer
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Clinical Implications of Systemic Inflammatory Response Markers as Independent Prognostic Factors in Colorectal Cancer Patients: Kwang Yeol Paik, In Kyu Lee, Yoon Suk Lee, Na Young Sung, Taek Soo Kwon; Cancer Res Treat. 2014;46(1):65-73. Published online January 15, 2014; DOI: https://doi.org/10.4143/crt.2014.46.1.65

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PURPOSE
Cancer-related inflammation affects many aspects of malignancy. We confirm the effects of early postoperative systemic inflammation on cancer prognosis.
MATERIALS AND METHODS
Six hundred consecutive patients underwent surgery for colorectal cancer from 2006 to 2009. Measurements of white blood cells, neutrophils, lymphocytes, monocytes, and platelet counts were performed preoperatively, daily until the fourth postoperative day, and subsequently every two days. Patients were divided into three groups based on the days spent on the leukocyte count to drop below 10,000/mm3 after surgery.
RESULTS
Preoperative white blood cell (WBC) counts correlated with stage of disease. In univariate survival analyses, tumor, node, metastasis (TNM) stage, and monocyte count were associated with cancer-free survival. In addition, cancer-free survival outcomes were worse in patients who required more than four days for the normalization of WBC count. A TNM stage greater than II and the neutrophil lymphocyte ratio were associated with the duration of overall survival. In a multivariate analysis of these significant variables, TNM stage, an interval longer than four days for normalization of WBC counts and monocyte count independently associated with cancer-free survival.
CONCLUSION
Postoperative early inflammatory phase and preoperative monocyte count correlate with poor colon cancer prognosis. We can conclude that preoperative and postoperative inflammatory response and period unfavorably affect the metastatic microenvironment.

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Current Concepts of Diagnosis and Management of Insulinoma: Chang Yong Sohn, You Sah Kim, In Kyu Lee, Seok Kil Zeon; J Korean Cancer Assoc. 1994;26(6):997-1005.

Abstract PDF: Insulinoma is a functional endocrine tumor arising from beta cells of the islets of Langerhans of the pancreas. The tumor is usually a benign, single adenoma and of small size (1~2 cm), and is evenly distributed throughout the pancreas. The symptoms and signs are triggered by hypoglycemia. Mechanisms for the production of symptoms are related to the neuroglycopenia causing cerebral dysfunction and the hypoglycemic stimulation of catechola- mine release. Complex symptoms originating from these mechanisms frequently lead to misdiagnosis as a neurologic or psychiatric disorder and delay proper treatment. Once suspicion of an insulinoma is made, the diagnosis is not complicated. Supervised fast until symptoms develop or for 72 hours bring the blood sugar level down below 50 mg/dl with inappropriately high endogenous insulin leveL C-peptide and proinsulin fraction measured at the termination of the fast confirm the diagnosis. Preoperative localization of a small insulinoma by ultrasono#graphy, arteriograh or computed tomography is not always successfuL Selective portal venous sampling for insulin has been found to be the most accurate method of localization. Careful exploration of the entire pancreas is very important at laparotomy and intraoperative ultrasonoaraphy is essential especially in identifying tumors in the head of the pancreas and in defining the relationship of the tumor to the pancreatic duct. We report our experience of three patients with insulinoma d uring the last five year period: one male 23 years old and two females, 38 and 40 years old. Preoperative localization failed in the first patient but in two patients, preoperative percutaneous transhepatic portal venous sampling for insulin helped to 1ocalize the tumor. A relatively well-demarcated mass lesion was found in each patient, and all three patients were treated with successful outcome. The sizes of the tumors were 1.5 x 1.0 x 1.0 cm, 2.7 x 2.2 x 1.4 cm, L.5 x 1.0 x 1.0 cm respectively.

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