A comparative analysis and guidance for individualized chemotherapy of stage II and III colorectal cancer patients based on pathological markers

Postoperative chemotherapy improves survival in patients with resected high-risk Stage II colorectal cancer: results of a systematic review and meta-analysis

AIM

The aim was to assess the benefit of adjuvant chemotherapy in high-risk Stage II colorectal cancer.

METHOD

A systematic literature review and meta-analysis was performed comparing survival in patients with resected Stage II colorectal cancer and high-risk features having postoperative chemotherapy vs no chemotherapy.

RESULTS

Of 1031 articles screened, 29 were included, reporting on 183 749 participants. Adjuvant chemotherapy significantly improved overall survival [hazard ratio (HR) 0.61, P < 0.0001], disease-specific survival (HR = 0.73, P = 0.05) and disease-free survival (HR = 0.59, P < 0.0001) compared to no chemotherapy. Adjuvant chemotherapy significantly increased 5-year overall survival (OR = 0.53, P = 0.0008) and 5-year disease-free survival (OR = 0.50, P = 0.001). Overall survival and disease-free survival remained significantly prolonged during subgroup analysis of studies published from 2015 onwards (HR = 0.60, P < 0.0001; HR = 0.65, P = 0.0001; respectively), in patients with two or more high-risk features (HR = 0.59, P = 0.0001; HR = 0.70, P = 0.03; respectively) and in colon cancer (HR = 0.61, P < 0.0001; HR = 0.51, P = 0.0001; respectively). Overall survival, disease-specific survival and disease-free survival during subgroup analysis of individual high-risk features were T4 tumour (HR = 0.58, P < 0.0001; HR = 0.50, P = 0.003; HR = 0.75, P = 0.05), < 12 lymph nodes harvested (HR = 0.67, P = 0.0002; HR = 0.80, P = 0.17; HR = 0.72, P = 0.02), poor differentiation (HR = 0.84, P = 0.35; HR = 0.85, P = 0.23; HR = 0.61, P = 0.41), lymphovascular or perineural invasion (HR = 0.55, P = 0.05; HR = 0.59, P = 0.11; HR = 0.76, P = 0.05) and emergency surgery (HR = 0.60, P = 0.02; HR = 0.68, P = 0.19).

CONCLUSION

Adjuvant chemotherapy in high-risk Stage II colorectal cancer results in a modest survival improvement and should be considered on an individual patient basis. Due to potential heterogeneity and selection bias of the included studies, and lack of separate rectal cancer data, further large randomized trials with predefined inclusion criteria and standardized chemotherapy regimens are required.

Identification of modules and functional analysis in CRC subtypes by integrated bioinformatics analysis

Colorectal cancer is one of the top three causes of cancer-related mortality globally, but no predictive molecular biomarkers are currently available for identifying the disease stage of colorectal cancer patients. Common molecular patterns in the disease, beyond superficial manifestations, can be significant in determining treatment choices. In this study, we used microarray data from colorectal cancer and adjacent normal tissue from the GEO database. These data were categorized into four consensus molecular subtypes based on distinct gene expression signatures. Weighted gene-based protein-protein interaction network analysis was performed for each subtype. NUSAP1, CD44, and COL4A1 modules were found to be statistically significant and present among all the subtypes and displayed though similar but not identical functional enrichment results. Reference of the characteristics of the subtypes to functional modules is necessary since the latter can stay resistant to platform changes and technique noise when compared with other analyses. The CMS4-mesenchymal group, which currently has a poor prognosis, was examined in the study. It is composed mainly of genes involved in immune and stromal expression, with modules focused on ECM dysregulation and chemokine biological processes. Hub genes detection and its' mapping into the protein-protein interaction network can be indicative of possible targets against specific modules. This approach identified subtypes using enrichment-oriented analysis in functional modules. Proper annotation of functional analysis of modules from different subtypes of CRC might be directive for finding extra options for treatment targets and guiding clinical routines.