scholarly journals Predictive value of pretreatment lymphocyte count in stage II colorectal cancer and in high-risk patients treated with adjuvant chemotherapy

Oncotarget ◽  
2015 ◽  
Vol 7 (1) ◽  
pp. 1014-1028 ◽  
Author(s):  
Lei Liang ◽  
Ji Zhu ◽  
Huixun Jia ◽  
Liyong Huang ◽  
Dawei Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Predictive Value ◽  
Lymphocyte Count ◽  
Stage Ii ◽  
High Risk Patients ◽  
Risk Patients ◽  
Stage Ii Colorectal Cancer

scholarly journals Stromal Expression of Vimentin Predicts the Clinical Outcome of Stage II Colorectal Cancer for High-Risk Patients

2017 ◽  
Vol 23 ◽  
pp. 2897-2905 ◽  
Author(s):  
Li-guo Liu ◽  
Xue-bing Yan ◽  
Ru-ting Xie ◽  
Zhi-ming Jin ◽  
Yi Yang
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Clinical Outcome ◽  
Stage Ii ◽  
High Risk Patients ◽  
Risk Patients ◽  
Stage Ii Colorectal Cancer

Genomic classifiers (ColoPrint/MSI-Print) predict outcome and chemotherapy benefit in stage II and III colon cancer patients.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 378-378 ◽  
Author(s):  
Scott Kopetz ◽  
Zhi-Qin Jiang ◽  
Michael J. Overman ◽  
Christa Dreezen ◽  
Sun Tian ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Additional Treatment ◽  
Low Risk ◽  
Stage Ii ◽  
High Risk Patients ◽  
Risk Patients

378 Background: Although the benefit of chemotherapy in stage II and III colon cancer patients is significant, many patients might not need adjuvant chemotherapy because they have a good prognosis even without additional treatment. ColoPrint is a gene expression classifier that distinguish patients with low or high risk of disease relapse. It was developed using whole genome expression data and has been validated in public datasets, independent European patient cohorts and technical studies (Salazar 2011 JCO, Maak 2012 Ann Surg). Methods: In this study, the commercial ColoPrint test was validated in stage II (n=96) and III patients (n=95) treated at the MD Anderson Cancer Center from 2003 to 2009. Frozen tissue specimen, clinical parameters, MSI-status and follow-up data (median follow-up 64 months) were available. The 64-gene MSI-signature developed to identify patients with deficient mismatch repair system (Tian 2012 J Path) was evaluated for its accuracy to identify MSI patients and also for prognosis. Results: In this cohort, ColoPrint classified 56% of stage II and III patients as being at low risk. The 3-year Relapse-Free-Survival (RFS) was 90.6% for Low Risk and 78.4% for High Risk patients with a HR of 2.33 (p=0.025). In uni-and multivariate analysis ColoPrint and stage were the only significant factors to predict outcome. The MSI-signature classified 47 patients (24.6%) as MSI-H and most MSI-H patients were ColoPrint low risk (81%). Patients who were ColoPrint low risk and MSI-H by signature had the best outcome with a 3-year RFS of 95% while patients with ColoPrint high risk had a worse outcome independently of the MSI-status. Low risk ColoPrint patients had a good outcome independent of stage or chemotherapy treatment (90.1% 3-year RFS for treated patients, 91.4% for untreated patients) while ColoPrint high risk patients treated with adjuvant chemotherapy had 3-year RFS of 84%, compared to 70.1% 3-year RFS in untreated patients (p=0.026). Conclusions: The combination of ColoPrint and MSI-Print improves the prognostic accuracy in stage II and stage III patients and may help the identification of patients at higher risk who are more likely to benefit from additional treatment

scholarly journals Impact of high-risk features for stage II adenocarcinoma of the appendix.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 795-795
Author(s):  
Mehmet Akce ◽  
Katerina Mary Zakka ◽  
Mckenna Penely ◽  
Renjian Jiang ◽  
Olatunji B. Alese ◽  
...  
Keyword(s):  
High Risk ◽  
Lymphovascular Invasion ◽  
Low Risk ◽  
Stage Ii ◽  
High Risk Patients ◽  
Risk Patients ◽  
Stage Ii Colorectal Cancer ◽  
Poorly Differentiated ◽  
Multivariable Analyses ◽  
The Impact

795 Background: Clinico-pathological high risk features are frequently utilized in adjuvant chemotherapy (AC) decisions in stage II colorectal cancer and their utility in stage II appendiceal adenocarcinoma (AA) is less established. The aim of this study is to determine the impact of high risk features on clinical outcomes and whether high risk features are predictive of AC benefit in stage II AA. Methods: Patients with pathological stage II AA between 2010 and 2015 were identified from the National Cancer Database (NCDB) using ICD-O-3 morphology and topography codes: 8140, 8480 and C18.1. High risk stage II AA was defined as having at least one of the following clinicopathological features: T4 tumor, < 12 lymph nodes examined, poorly differentiated histology, positive margins, or lymphovascular invasion. Patients with none of these features were defined as low-risk. Results: A total of 1,040 patients were identified. 51.0% males, 84.5% Caucasian; median age 61 (range, 19-90). 46.4% were determined to have high-risk stage II AA. High-risk status was associated with worse OS compared to low-risk in univariate (HR 1.55; 95% CI 1.18-2.02; p = 0.001) and multivariable analyses (HR 1.36; 95% CI 1.03-1.79; p = 0.028). High-risk stage II AA patients had significantly worse 5-year OS compared to low-risk patients (67.1% vs. 74.5%, p = 0.0013). AC was administered in 34.4% (n = 166) of high-risk patients and in 36.5% (n = 203) of low-risk patients. Among high-risk patients, AC was not associated with better OS in univariate (HR 0.86; 95% CI 0.59-1.26; p = 0.722) and multivariable analyses (HR 1.35; 95% CI 0.90-2.04; p = 0.324) compared to no AC. Similarly, among low-risk patients, AC was not associated with better OS in univariate (HR 0.92; 95% CI 0.60-1.39; p = 0.813) and multivariable analyses (HR 1.27; 95% CI 0.81-2.02; p = 0.334) compared to no AC. For high-risk patients, 5-year OS was 68.3% in patients that received AC vs. 66.5% in patients that did not (p = 0.722). For low-risk patients, 5-year OS was 74.0% in patients that received AC vs. 76.3% in patients that did not (p = 0.813). Conclusions: High-risk stage II AA patients had significantly worse 5-year OS compared to low-risk patients. AC did not improve survival regardless of high risk features in stage II AA.

Comparison of ColoPrint risk classification with clinical risk in the prospective PARSC trial.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 465-465 ◽  
Author(s):  
Ramon Salazar ◽  
Jaume Capdevila ◽  
Robert Rosenberg ◽  
Jan Willem de Waard ◽  
Bengt Glimelius ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Prospective Study ◽  
The United States ◽  
Risk Classification ◽  
Low Risk ◽  
Stage Ii ◽  
High Risk Patients ◽  
Clinical Risk ◽  
Risk Patients

465 Background: The 18-gene expression profile, ColoPrint, has been developed and validated for identifying risk of recurrence in patients with early-stage colon cancer (CC). In a pooled stage II validation study ColoPrint identified 63% of patients as Low Risk with a 3-yr recurrence-free survival (RFS) of 93% while High Risk patients had a 3-yr RFS of 82% with a HR of 2.7 (p=0.001). PARSC is a prospective study for the assessment of recurrence risk in stage II CC patients using ColoPrint. ColoPrint classification is compared to NCCN risk classification. Methods: The study enrolled 468 patients with histologically proven stage II CC from 31 institutes in Europe, the United States, and Asia between October 2008 and May 2013. Synchronous tumors were excluded. ColoPrint results were not disclosed to the physician and patient. Treatment was at the discretion of the physician, adhering to NCCN approved regimens or a recognized alternative. A McNemars test is performed to compare ColoPrint with NCCN risk classification. A p value ≤ 0.05 indicates the two tests differ significantly. Results: ColoPrint classified 320 (68%) patients as Low Risk and 148 (32%) as High Risk. 89 patients (19%) received adjuvant chemotherapy. In the ColoPrint Low Risk group, 57 (18%) patients received adjuvant chemotherapy while 32 (22%) of ColoPrint High Risk patients received chemotherapy. According to NCCN high risk factors (T4, high grade (exclusive of MSI-H), lymphovascular/perineural invasion, perforation/obstruction, <12 nodes examined, positive margins) 234 (50%) patients were NCCN Low Risk and 234 were NCCN High Risk. 72 (31%) of the NCCN Low Risk patients are ColoPrint High Risk. 158 (68%) of the NCCN High Risk patients are ColoPrint Low Risk. MSI-status was assessed in 86 (18%) patients of which 29 were MSI high and 57 were MSS. All MSI high were classified as ColoPrint Low Risk. Conclusions: The PARSC study is the first prospective study to compare genomic and clinical risk assessment and we observed marked differences between NCCN risk classification and ColoPrint. The clinical validity of these methods will be based on the outcomes at 3 and 5 years. Clinical trial information: NCT00903565. [Table: see text]

Immunological nomograms predicting prognosis and guiding adjuvant chemotherapy in stage II colorectal cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 499-499
Author(s):  
Junjie Peng ◽  
Yaqi Li ◽  
Yang Feng
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Tumor Infiltrating Lymphocytes ◽  
Risk Groups ◽  
High Risk Group ◽  
Stage Ii ◽  
Stage Ii Colorectal Cancer

499 Background: The type, abundance, and location of tumor-infiltrating lymphocytes (TILs) have been associated with prognosis in colorectal cancer. The objective of this study was to assess the prognostic role of TILs and develop a nomogram for accurate prognostication of stage II colorectal cancer. Methods: Immunohistochemistry was conducted to assess the densities of intraepithelial and stromal CD3+, CD8+, CD45RO+ and FOXP3+ TILs, and to estimate PD-L1 expression in tumor cells for 168 patients with stage II colorectal cancer. The prognostic roles of these features were evaluated using COX regression model, and nomograms were established to stratify patients into low and high-risk groups and compare the benefit from adjuvant chemotherapy. Results: In univariate analysis, patients with high intraepithelial or stromal CD3+, CD8+, CD45RO+ and FOXP3+ TILs were associated significantly with better relapse-free survival (RFS) and overall survival (OS), except for stromal CD45RO+ TILs, whereas PD-L1 expression wasn't associated with RFS or OS. In multivariate analysis, patients with high intraepithelial CD3+ and stromal FOXP3+ TILs were associated with better RFS (p < 0.001 and p = 0.032, respectively), while only stromal FOXP3+ TILs was an independent prognostic factor for OS (p = 0.031). The nomograms were well calibrated and showed a c-index of 0.751 and 0.757 for RFS and OS, respectively. After stratifying into low and high-risk groups, the high-risk group exhibited a better OS from adjuvant chemotherapy (3-year OS of 81.9% v 34.3%, p = 0.006). Conclusions: These results may help improve the prognostication of stage II colorectal cancer and identify a high-risk subset of patients who appeared to benefit from adjuvant chemotherapy.

JCOG1805 (PanDRa-BD study): A randomized controlled study of adjuvant chemotherapy for stage II colorectal cancer patients at high-risk of developing recurrence according to T-stage and three selected pathological factors (Pn, DR, and BD).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS3621-TPS3621
Author(s):  
Megumi Ishiguro ◽  
Hideki Ueno ◽  
Atsuo Takashima ◽  
Junki Mizusawa ◽  
Keita Sasaki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Multicenter Study ◽  
Prognostic Value ◽  
Stage Ii ◽  
Randomized Controlled ◽  
T Stage ◽  
Stage Ii Colorectal Cancer

TPS3621 Background: Adjuvant chemotherapy for stage II colorectal cancer (CRC) still remains controversial. Although the NCCN and ESMO guidelines recommend adjuvant chemotherapy for patients with “high-risk features,” the survival benefit has not been confirmed. We reviewed the evidence levels for prognostic values of risk factors, because lack of their robustness is a major source of uncertainty regarding the optimal indication of adjuvant chemotherapy. Consequently, on top of the T-stage, three pathological factors—perineural invasion (Pn), tumor budding (BD), and desmoplastic reaction (DR)—were selected as robust risk factors of recurrence. Among the conventional factors, the prognostic value of Pn had been well validated in a multicenter study conducted by the Japanese Society for Cancer of the Colon and Rectum (JSCCR; Am J Surg Path 2013), but others were deemed suboptimal in terms of the prognostic value. BD and DR are novel tumor- and stroma-factors, respectively, associated with cancer microenvironment at the tumor front. According to the JSCCR and ITBCC 2016 criteria, tumors are graded as BD1, BD2, or BD3. The DR heterogeneity is categorized into Mature, Intermediate, and Immature patterns based on site-specific products of cancer-associated fibroblasts—keloid-like collagen and myxoid stroma. According to a recent prospective multicenter study, BD and DR characterization represent a higher level of prognostic value than other conventional factors (SACURA trial; J Clin Oncol 2019, Br J Cancer 2021). Based on the four selected risk factors, we can exclude the patient group with favorable prognosis (i.e., > 90% of 5-year RFS), which accounts for approximately 40% of the total population, resulting in enabling us to identify the concentrated population of high risk of developing recurrence. Methods: The Japan Clinical Oncology Group (JCOG) launched a randomized controlled phase III trial to evaluate the superiority of adjuvant chemotherapy in terms of relapse-free survival (RFS) over observation only in stage II CRC patients aged 20–80 years having one or more of the following risk factors: pathological T4, Pn, BD3, and non-Mature DR. Patients are randomised, in a 1:1:1 ratio, to [A] observation, [B] capecitabine monotherapy for 6 months, or [C] capecitabine and oxaliplatin (CAPOX) for 3 months. A total of 1680 patients will be accrued from 54 Japanese institutions assuming 3-year RFS with [A] to be 82% and expected 5% increase in 3-year RFS for [B] and [C] with one-sided alpha of 2.5% and power of 80% for each pair comparison. Patient enrollment was started in January 2020 and 170 patients have been enrolled until January 2021. This trial has been registered at Japan Registry of Clinical Trials as jRCTs031190186. Clinical trial information: jRCTs031190186.

scholarly journals Is the benefit of adjuvant chemotherapy limited to high-risk stage ii colorectal cancer?

2016 ◽  
Vol 27 ◽  
pp. iv46
Author(s):  
M. Roberto ◽  
A. Romiti ◽  
E. Pilozzi ◽  
G. Balducci ◽  
M. Ferri ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Stage Ii ◽  
Stage Ii Colorectal Cancer
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