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prognosis after surgical resection of colorectal carcinoma

Tumor stage is the most important prognostic factor in a patient with newly diagnosed colorectal cancer [4] Predictors of poor outcome: 1) tumor spread to regional lymph nodes 2) number of regional lymph nodes involved 3) tumor penetration through the bowel wall 4) poorly differentiated histology 5) perforation 6) tumor adherence to adjacent organs 7) venous invasion 8) preoperative elevation of CEA titer (> 5.0 ng/mL) 9) aneuploidy 10) specific chromosome deletion(s) - allelic loss on chromosome 18q 11) poor performance status (best predictor of poor prognosis) Stage 3: 1) 45% 5 year survival without chemotherapy [2] 2) disease-free survival improved with adjuvant chemotherapy (3-6 months) - chemotherapy with FOLFOX or CAPOX for 3 or 6 months - time to recurrence similar in elderly > 70 years vs younger patients - overall & disease-free survival lower in elderly > 70 years - overall & disease-free survival similar for 3 vs 6 months of chemotherapy [5] 3) survival improved with adequate lymph node dissection [3] 4) reverse transcriptase, polymerase chain reaction analysis of lymph node biopsy specimens taken during surgery for resection of colon cancer may allow for identification of submicroscopic metastases of tumor to local lymph nodes

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prognosis

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 576
  2. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  3. Chen SL and Bilchik AJ More extensive nodal dissection improves survival for stages I-III of colon cancer: A population-based study. Ann Surg 2006, 244:602 PMID: 16998369
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. Gallois C, Shi Q, Pederson LD et al. Oxaliplatin-based adjuvant chemotherapy in older patients with stage III colon cancer: An ACCENT/IDEA pooled analysis of 12 trials. J Clin Oncol 2024 Mar 28; [e-pub] PMID: 38547438 https://ascopubs.org/doi/10.1200/JCO.23.01326