The role of adjuvant chemotherapy in stage II colorectal cancer patients

Hung Hsin Lin, Yu Yao Chang, Jen Kou Lin, Jeng Kai Jiang, Chun Chi Lin, Yuan Tzu Lan, Shung Haur Yang, Huann Sheng Wang, Wei Shone Chen, Tzu Chen Lin, Shih Ching Chang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Purpose: Adjuvant chemotherapy use in stage II colorectal cancer (CRC) is debated. We evaluated the prognostic significance of clinicopathological features recommended by most guidelines for identifying high-risk stage II CRC and adjuvant chemotherapeutic response. Methods: We enrolled 1,039 stage II CRC patients who underwent curative surgery at Taipei Veterans General Hospital from January 2005 to December 2010. Seventy-seven patients who received radiotherapy were excluded. The endpoint was disease-free survival. Results: Of 962 patients, 37 had stage T4 tumors; 50, lymphovascular invasion; 39, poor differentiation; 249, preoperative carcinoembryonic antigen (CEA) levels >5 ng/mL; and 53 underwent emergent operations. One hundred ninety-four patients received 5-fluorouracil-based adjuvant chemotherapy. During a median follow-up period of 60.2 months, recurrence developed in 110 patients (11.4 %). The 5-year disease-free survival (DFS) was 87.6 %. In multivariate analysis, preoperative CEA >5 ng/ml (p = 0.001), emergent operation for obstruction/perforation (p = 0.008), lymphovascular invasion (p = 0.014), and T4 disease (p = 0.030) were significantly associated with poor DFS. High-risk stage II patients (n = 484) benefited from adjuvant chemotherapy (5-year DFS with and without adjuvant chemotherapy, 87.3 vs. 78.9 %; p = 0.028). Conclusions: Adjuvant chemotherapy improved DFS in high-risk stage II CRC patients, but not in low-risk patients.

Original languageEnglish
Pages (from-to)1237-1243
Number of pages7
JournalInternational Journal of Colorectal Disease
Issue number10
StatePublished - Oct 2014


  • 5-FU
  • Colorectal cancer
  • High CEA
  • Recurrence
  • Risk factor


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