J Yeungnam Med Sci.  2022 Apr;39(2):141-149. 10.12701/yujm.2021.01571.

Clinical implication of adjuvant chemotherapy according to mismatch repair status in patients with intermediate-risk stage II colon cancer: a retrospective study

• Kang BW
• Baek DW
• Chang E
• Kim HJ
• Park SY
• Park JS
• Choi GS
• Baek JH
• Kim JG

• KMID: 2529272
• DOI: http://doi.org/10.12701/yujm.2021.01571

Abstract

Background
The present study evaluated the clinical implications of adjuvant chemotherapy according to the mismatch repair (MMR) status and clinicopathologic features of patients with intermediate- and high-risk stage II colon cancer (CC).
Methods
This study retrospectively reviewed 5,774 patients who were diagnosed with CC and underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The patients were enrolled according to the following criteria: (1) pathologically diagnosed with primary CC; (2) stage II CC classified based on the 7th edition of the American Joint Committee on Cancer staging system; (3) intermediate- and high-risk features; and (4) available test results for MMR status. A total of 286 patients met these criteria and were included in the study.
Results
Among the 286 patients, 54 (18.9%) were identified as microsatellite instability-high (MSI-H) or deficient MMR (dMMR). Although all the patients identified as MSI-H/dMMR showed better survival outcomes, T4 tumors and adjuvant chemotherapy were identified as independent prognostic factors for survival. For the intermediate-risk patients identified as MSI-low (MSI-L)/microsatellite stable (MSS) or proficient MMR (pMMR), adjuvant chemotherapy exhibited a significantly better disease-free survival (DFS) but had no impact on overall survival (OS). Oxaliplatin-containing regimens showed no association with DFS or OS. Adjuvant chemotherapy was not associated with DFS in intermediate-risk patients identified as MSI-H/dMMR.
Conclusion
The current study found that the use of adjuvant chemotherapy was correlated with better DFS in MSI-L/MSS or pMMR intermediate-risk stage II CC patients.

Keyword

Adjuvant chemotherapy; Colon cancer; Intermediate risk; Mismatch repair; Stage II

Figure

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  Fig. 1. Flow diagram of patient selection. CC, colon cancer; MMR, mismatch repair; MSI, microsatellite instability; MSI-H, MSI-high; dMMR, deficient MMR; MSI-L, MSI-low; MSS, microsatellite stable; pMMR, proficient MMR.

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  Fig. 2. Kaplan-Meier survival curves ffor (A) disease-free and (B) overall survival of patients with intermediate-risk stage II colon cancer and microsatellite instability-low/microsatellite stable according to adjuvant chemotherapy.

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  Fig. 3. Kaplan-Meier survival curves for (A) disease-free and (B) overall survival of patients with intermediate-risk stage II colon cancer and microsatellite instability-low/microsatellite stable or proficient mismatch repair according to type of adjuvant chemotherapy.

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  Fig. 4. Kaplan-Meier survival curves for disease-free survival of patients with intermediate-risk stage II colon cancer and microsatellite instability-high or deficient mismatch repair according to adjuvant chemotherapy.

Reference

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