Adjuvant Therapy for Stage II Colon Cancer: A Systematic Review From the Cancer Care Ontario Program in Evidence-Based Care’s Gastrointestinal Cancer Disease Site Group

作者：Alvaro Figueredo, Manya L. Charette, Jean Alfred Maroun, Melissa C. Brouwers, Lisa Zuraw · 发表于：Journal of Clinical Oncology · 年份：2004 · DOI：10.1200/jco.2004.03.087 · 被引用次数：353 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal Cancer Treatments and Studies、Gastric Cancer Management and Outcomes

PURPOSE: To develop a systematic review that would address the following question: Should patients with stage II colon cancer receive adjuvant therapy? METHODS: A systematic review was undertaken to locate randomized controlled trials comparing adjuvant therapy to observation. RESULTS: Thirty-seven trials and 11 meta-analyses were included. The evidence for stage II colon cancer comes primarily from a trial of fluorouracil plus levamisole and a meta-analysis of 1,016 patients comparing fluorouracil plus folinic acid versus observation. Neither detected an improvement in disease-free or overall survival for adjuvant therapy. A recent pooled analysis of data from seven trials observed a benefit for adjuvant therapy in a multivariate analysis for both disease-free and overall survival. The disease-free survival benefits appeared to extend to stage II patients; however, no P values were provided. A meta-analysis of chemotherapy by portal vein infusion has also shown a benefit in disease-free and overall survival for stage II patients. A meta-analysis was conducted using data on stage II patients where data were available (n = 4,187). The mortality risk ratio was 0.87 (95% CI, 0.75 to 1.01; P =.07). CONCLUSION: There is preliminary evidence indicating that adjuvant therapy is associated with a disease-free survival benefit for patients with stage II colon cancer. These benefits are small and not necessarily associated with improved overall survival. Patients should be made aware o...