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This article comes from the NEJM Journal Watch Adjuvant Chemotherapy Benefits MSI Stage III Colon Cancer Adjuvant Chemotherapy is beneficial to patients with microsatellite instability stage III Colon Cancer Comment Author: David H.
Ilson, MD, PhD Oxaliplatin combined with fluoride Pyrimidine (FP) shows a survival advantage, especially in patients with stage N1 colon cancer.
Microsatellite instability (MSI) stage II colon cancer patients can achieve a high postoperative survival rate without adjuvant therapy.
The impact of MSI on stage III colon cancer is still unclear.
The current treatment guidelines recommend the use of FP and oxaliplatin for adjuvant therapy.
In order to assess the impact of MSI status in patients with stage III colon cancer receiving adjuvant therapy, the investigators conducted a pooled analysis of 12 randomized trials included in the ACCENT database.
Four trials studied FP + oxaliplatin, two trials compared FP with FP + oxaliplatin, and six trials compared surgery with surgery + FP.
Of the 5,457 patients, 11% had MSI or DNA mismatch repair protein defects, and 89% had microsatellite stable (MSS) colon cancer.
MSI tumors are more common in the right colon (84.
1%), women (51.
9%), and stage T1-3 colon cancer (83.
9%).
During a median follow-up of 7.
2 years, MSI status has an impact on the efficacy of chemotherapy regimens and patient survival.
Compared with surgery alone, FP adjuvant therapy alone has no survival benefit for patients with stage III colon cancer with high MSI (5-year overall survival rate, 0.
73 and 0.
74).However, in MSI patients, the survival rate of FP+oxaliplatin was significantly higher than that of FP therapy alone (hazard ratio, 0.
52), and the survival rate of this patient population was more affected than that of MSS patients (hazard ratio, 0.
89).
Among MSI patients, the 5-year survival rate after treatment with oxaliplatin (85.
0%) was improved compared with FP treatment alone (73.
7%).
The prognosis of patients with high MSI receiving FP+oxaliplatin adjuvant treatment is better than that of MSS patients, but the above-mentioned better outcomes are only seen in N1 stage colon cancer (risk ratio, 0.
66), but not in N2 stage colon cancer (risk ratio, 1.
13) ).
Comment This analysis confirms the benefits of FP+Oxaliplatin adjuvant therapy for MSI stage Ⅲ colon cancer, and the efficacy and prognosis may be better than MSS stage Ⅲ colon cancer, which is particularly beneficial for N1 stage colon cancer.
Although adjuvant therapy with FP alone is harmless, it has no survival benefit for patients with MSI stage III colon cancer.
Cohen R et al.
Microsatellite instability in patients with stage III colon cancer receiving fluoropyrimidine with or without oxaliplatin: An ACCENT pooled analysis of 12 adjuvant trials.
J Clin Oncol 2021 Feb 20; 39:642.
(https://doi .
org/10.
1200/JCO.
20.
01600) NEJM Journal Watch (NEJM Journal Watch) is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
Ilson, MD, PhD Oxaliplatin combined with fluoride Pyrimidine (FP) shows a survival advantage, especially in patients with stage N1 colon cancer.
Microsatellite instability (MSI) stage II colon cancer patients can achieve a high postoperative survival rate without adjuvant therapy.
The impact of MSI on stage III colon cancer is still unclear.
The current treatment guidelines recommend the use of FP and oxaliplatin for adjuvant therapy.
In order to assess the impact of MSI status in patients with stage III colon cancer receiving adjuvant therapy, the investigators conducted a pooled analysis of 12 randomized trials included in the ACCENT database.
Four trials studied FP + oxaliplatin, two trials compared FP with FP + oxaliplatin, and six trials compared surgery with surgery + FP.
Of the 5,457 patients, 11% had MSI or DNA mismatch repair protein defects, and 89% had microsatellite stable (MSS) colon cancer.
MSI tumors are more common in the right colon (84.
1%), women (51.
9%), and stage T1-3 colon cancer (83.
9%).
During a median follow-up of 7.
2 years, MSI status has an impact on the efficacy of chemotherapy regimens and patient survival.
Compared with surgery alone, FP adjuvant therapy alone has no survival benefit for patients with stage III colon cancer with high MSI (5-year overall survival rate, 0.
73 and 0.
74).However, in MSI patients, the survival rate of FP+oxaliplatin was significantly higher than that of FP therapy alone (hazard ratio, 0.
52), and the survival rate of this patient population was more affected than that of MSS patients (hazard ratio, 0.
89).
Among MSI patients, the 5-year survival rate after treatment with oxaliplatin (85.
0%) was improved compared with FP treatment alone (73.
7%).
The prognosis of patients with high MSI receiving FP+oxaliplatin adjuvant treatment is better than that of MSS patients, but the above-mentioned better outcomes are only seen in N1 stage colon cancer (risk ratio, 0.
66), but not in N2 stage colon cancer (risk ratio, 1.
13) ).
Comment This analysis confirms the benefits of FP+Oxaliplatin adjuvant therapy for MSI stage Ⅲ colon cancer, and the efficacy and prognosis may be better than MSS stage Ⅲ colon cancer, which is particularly beneficial for N1 stage colon cancer.
Although adjuvant therapy with FP alone is harmless, it has no survival benefit for patients with MSI stage III colon cancer.
Cohen R et al.
Microsatellite instability in patients with stage III colon cancer receiving fluoropyrimidine with or without oxaliplatin: An ACCENT pooled analysis of 12 adjuvant trials.
J Clin Oncol 2021 Feb 20; 39:642.
(https://doi .
org/10.
1200/JCO.
20.
01600) NEJM Journal Watch (NEJM Journal Watch) is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
