Factores clínicos, bioquímicos, anatomopatológicos y moleculares predictivos de recidiva en el cáncer de colon sin afectación ganglionar

Resumen

INTRODUCTION. Cancer of the colon and rectum is the second most frecuent neoplasic disease in women and the third in men in the world. Colon cancer prognosis when lymph nodes are not involved is quite good, with a five-years-survival estimated between 70-87 %. Current oncologic guides do not recommend rutinary adjuvant chemotherapy in colon cancer patients without involvement of lymph nodes because there is not enough evidence of the benefit in either disease-free survival or overall survival. Actually, there are several studies ongoing trying to detect which factors, either from the patient, the anatomopathologic analysis of the specimen and the molecular analysis of the tumor could give the tools to select those patients whom would benefit from adjuvant chemotherapy when the colon cancer has not spread to the lymph nodes. MATERIALS AND METHODS. This is a retrospective cohorts study involving 141 patients with the diagnosis of T2-T4 N0 colon cancer in the specimen, operated in Hospital Universitario Ramón y Cajal (Madrid, Spain) between 1975 and 2007. We analyzed during the surveillance the occurrence of local or distant recurrence. We study retrospectively clinical, biochemical factors of the patients and anatomopathologic and molecular factors of the specimens. RESULTS. From the group of 141 patients, 25 (18%) of them developed recurrence during surveillance. The overall survival median in the recurrence group was 45 months and 78 months in the free-disease group. The univariant analysis showed worse prognosis with significant differences in disease-free-survival in the deepness of the tumor invasion (T status), vascular infiltration and microsatellites instability. The immunochemistry for C-kit or c-myc and absence of 12 or more lymph nodes in the specimen were adverse prognosis factors nearby the statistic significance. CONCLUSIONS. The presence of several risk factors as T4, vascular infiltration, microsatellite instability, less than 12 lymph nodes in the specimen or positive immunochemistry to c-kit or c-myc in patients with resected T2-T4 N0 colon cancer will give those patients a higher risk of recurrence, and so adjuvant chemotherapy should be proposed to them. There is still a long way to go in the study of which factors could be prognostic of recurrence in colon cancer stage II (T3-T4 N0) after oncologic surgery, and they will determinate the individual risk of each patient.