Adjuvant chemotherapy for resected stage II colon cancer

* High-risk clinicopathologic features include:

• <12 sampled lymph nodes
• Perineural or lymphovascular invasion
• Clinical intestinal obstruction
• Tumor perforation
• Grade BD3 tumor budding (10 buds or more)
• Poorly differentiated or undifferentiated tumor grade (except for dMMR/MSI-H tumors)

¶ Adjuvant fluoropyrimidine-only chemotherapy is not generally recommended for patients with dMMR/MSI-H tumors.

Δ Compared with a fluoropyrimidine alone, an oxaliplatin-based regimen may have little to no effect on disease-free or overall survival in patients at high risk of recurrence; while it might improve the time to recurrence (delay relapse), it also worsens grade 3 peripheral neuropathy during treatment. We reserve this approach for patients with pT4 primary tumor or 2 or more high-risk factors.

◊ For patients with a T4 primary, adjuvant chemotherapy probably improves overall and relapse-free survival; for patients with high-risk factors other than a T4 primary tumor, the benefits of adjuvant chemotherapy are less certain, but the presence of more than 1 risk factor may increase the risk for recurrence.