IDENTIFYING STAGE-B COLORECTAL-CANCER PATIENTS AT HIGH-RISK OF TUMOR RECURRENCE AND DEATH

PURPOSE: This study was designed to determine clinical and pathologic variables associated with poor outcome following resection of Stage B colorectal cancer. METHODS: This was a retrospective study of 117 pati ents with Stage B cancer who underwent curative surgery and survived t he postoperative period. Fourteen clinical and pathologic features wer e studied. Clinical data were extracted from a prospective colorectal cancer database, and histologic slides were retreived and examined by a pathologist blinded as to clinical details and outcome. RESULTS: Aft er a median follow-up period of 8.2 years, bowel obstruction was signi ficantly related to a poor prognosis (log-rank test; P = 0.03). Extens ive necrosis (P = 0.01) and perineural invasion (P = 0.03) were also a ssociated with decreased survival. Vascular invasion was associated wi th poor long-term outcome in the subgroup of patients with rectal (P = 0.07) but not colonic (P = 0.57) cancer. Multivariate regression anal ysis identified both tumor necrosis (P = 0.01) and perineural invasion (P = 0.03) as independently related to outcome. CONCLUSION: Further s tudy of prognostic indicators might result in an algorithm to distingu ish Stage B cases at high risk of tumor recurrence and death. Such pat ients could be included in future trials of adjuvant therapies.