A New Prognostic and Predictive Tool for Shared Decision Making in Stage III Colon Cancer

European Journal of Cancer
24 Sep, 2020 ,

In view of a wide variation in survival of patients with stage III colon cancer according to T-N sub-stages, it appears that determination of the benefit of each therapeutic option in each T-N subgroup may yield more precise information and will assist doctors and patients in the complex shared decision-making process surrounding adjuvant therapy. From the IDEA trial, they retrieved the outcomes data of 12,834 patients with stage III colon cancer and categorized the patients in 16 sub-stages, based on T-N categories. The subgroups were noted to vary largely in 5-year DFS rate, ranging from 89% (T1N1a) to 31% (T4N2b) in the overall population. Wide variation was noted in the contribution of each therapeutic option across sub-stages. The resulting overlay bar graph indicated the absolute advantage of each treatment option. The model indicated a projected 5-year DFS of 79.6% for patients with T1N1a cancers in correlation with receiving surgery alone. A 5.6% absolute DFS gain was recorded in correlation with providing adjuvant fluoropyrimidine alone; an additional 2.3% and 0.8% gain is noted with oxaliplatin for 3 and 6 months, respectively. Patients with T4N2b cancers displayed a 13.9% 5-year DFS with surgery alone, and an 11.2%, 6.4%, 2.5% rise with the aforementioned adjuvant options, respectively.