Microsatellite instability and adjuvant chemotherapy in stage II colon cancer Journal Article


Authors: Koenig, J. L.; Toesca, D. A. S.; Harris, J. P.; Tsai, C. J.; Haraldsdottir, S.; Lin, A. Y.; Pollom, E. L.; Chang, D. T.
Article Title: Microsatellite instability and adjuvant chemotherapy in stage II colon cancer
Abstract: Background:Randomized control trials and population-based studies do not demonstrate a definitive benefit for adjuvant chemotherapy (ACT) in stage II colon cancer (CC). Tumor sidedness and microsatellite instability (MSI) status may predict response to ACT, but previous studies have limited microsatellite data. We assessed the efficacy of ACT and possible interaction with MSI status and tumor sidedness in patients with resected stage II CC diagnosed between 2010 and 2013 using the National Cancer Database.Materials and Methods:Overall survival was evaluated with the Kaplan-Meier method and multivariate and propensity score matched Cox proportional hazards models. The interaction between receipt of ACT, MSI status, and tumor sidedness was evaluated. The efficacy of ACT was assessed in patient subgroups by MSI status and tumor sidedness.Results:Among 6964 stage II CC patients with known MSI status, 1497 (21.5%) received ACT, 843 had MSI tumors, and 6121 had microsatellite stable (MSS) tumors. In multivariate and propensity score matched analyses, ACT was associated with improved survival after adjusting for factors including high-risk features, MSI status, and tumor sidedness (multivariate hazard ratio, 0.52; P<0.001). There was no interaction between receipt of ACT and MSI status (P=0.25). Patients with MSS tumors benefitted from ACT (multivariate hazard ratio, 0.47; P<0.001), even without other high-risk features. Patients with MSI tumors did not (P=0.671). ACT was associated with improved survival regardless of tumor sidedness.Conclusions:MSS alone may warrant ACT in stage II CC while patients with MSI tumors may not derive significant benefit from ACT.. © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: adjuvant chemotherapy; microsatellite instability; stage ii colon cancer; national cancer database; tumor sidedness
Journal Title: American Journal of Clinical Oncology
Volume: 42
Issue: 7
ISSN: 0277-3732
Publisher: Lippincott Williams & Wilkins  
Date Published: 2019-07-01
Start Page: 573
End Page: 580
Language: English
DOI: 10.1097/coc.0000000000000554
PUBMED: 31166206
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
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  1. Chiaojung Jillian   Tsai
    201 Tsai