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Who to treat with adjuvant therapy in Dukes B/Stage II colorectal cancer? - The need for high quality pathology,
  1. Eva Morris (eva.morris{at}nycris.leedsth.nhs.uk)
  1. University of Leeds, United Kingdom
    1. Nicola J Maughan (nicmaughan{at}hotmail.com)
    1. University of Leeds, United Kingdom
      1. David Forman (d.forman{at}leeds.ac.uk)
      1. University of Leeds, United Kingdom
        1. Philip Quirke (patpq{at}leeds.ac.uk)
        1. University of Leeds, United Kingdom

          Abstract

          Objective: Identify by routine pathology which Dukes B colorectal cancer patients may benefit from chemotherapy.

          Design & Setting: Retrospective study of the five-year survival of colorectal cancer patients for whom colorectal pathology minimum datasets had been collected between 1997 and 2000 in the Yorkshire region of the UK

          Patients: The study population consisted of 1,625 Dukes B and 480 Dukes C patients who possessed one positive node. treated between 1997 and 2000.

          Main Outcome Measures: The predictive ability of the Petersen prognostic model was investigated and survival of Dukes B patients with potentially high-risk pathological features was compared to that of Dukes C patients with one positive node.

          Results: Only 23.3% of patients had all the pathological variables required for the application of Petersen's index reported. The index offered a statistically significant survival difference of 24.3% and 30.3% between high- and low-risk colon (P<0.01) and rectal cancer patients (P<0.01). The size of these effects was smaller than predicted by the original model. Survival of Dukes B patients with any of the high-risk pathological factors or low nodal yields was lower than that of Dukes C patients who possessed one positive node.

          Conclusion: Petersen's index discriminated between high- and low-risk Dukes B colorectal tumours, but inadequate pathological reporting diminished its ability to identify all high-risk patients. The survival of patients with any high-risk feature was lower than the threshold for adjuvant therapy of one lymph node positive Dukes C colorectal cancers. Chemotherapy may benefit patients with such features. Improving the quality of pathological reporting is vital if high-risk patients are to be reliably identified.

          • Colorectal neoplasms
          • adjuvant treatment
          • pathology
          • staging

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