Efficacy of adjuvant chemotherapy in stage II colon cancer patients with twelve or more lymph nodes retrieve

doi:10.4251/wjgo.v17.i9.108470

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Oncol. Sep 15, 2025; 17(9): 108470
Published online Sep 15, 2025. doi: 10.4251/wjgo.v17.i9.108470

Efficacy of adjuvant chemotherapy in stage II colon cancer patients with twelve or more lymph nodes retrieve

Yu Huo, Yue-Yang Zhang, Shuai Jiao, Zhong-Yuan Bai, Wen-Qi Bai, Hai-Tao Zhou, Xu Guan

Yu Huo, Department of Colorectal Surgery, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030000, Shanxi Province, China

Yue-Yang Zhang, Hai-Tao Zhou, Xu Guan, Department of Colorectal Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China

Shuai Jiao, Shanxi Cancer Hospital, Taiyuan 030000, Shanxi Province, China

Zhong-Yuan Bai, Department of General Surgery, First Clinical Medical School, Shanxi Medical University, Taiyuan 030000, Shanxi Province, China

Wen-Qi Bai, Department of General Surgery Sciences, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030000, Shanxi Province, China

Co-first authors: Yu Huo and Yue-Yang Zhang.

Co-corresponding authors: Wen-Qi Bai and Hai-Tao Zhou.

Author contributions: Huo Y, Zhang YY, Jiao S, and Bai ZY wrote the manuscript, performed the statistical analysis, created a database, and selected the patients; Huo Y and Zhang YY made equal contributions as co-first authors; Guan X, Zhou HT, and Bai WQ critically revised the manuscript; Bai WQ designed and directed the entire study; Bai WQ and Zhou HT made equal contributions as co-corresponding authors. All authors approved the final version to publish.

Supported by Shanxi Special Projects of the Central Government Guiding Local Science and Technology Development of China, No. YDZJSX2021B016; and Shanxi Cancer Hospital Doctoral Master’s Guide and Companion Flying Fund, No. SD2023010.

Institutional review board statement: This study was carried out in accordance with the ethical principles outlined in the Declaration of Helsinki for medical research involving human participants, and was approved by the Institutional Review Board of Shanxi Hospital Affiliated to Cancer Hospital Chinese Academy of Medical Sciences (Shanxi Province Cancer Hospital), No. KY2024178.

Informed consent statement: Informed consent was not obtained from participants, but the data used in this study have been anonymized to minimize the likelihood of identification.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Wen-Qi Bai, Professor, Department of General Surgery Sciences, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Xinghualing District Workers’ New Village, Taiyuan 030000, Shanxi Province, China. baiwenqi1998@163.com

Received: April 15, 2025
Revised: May 26, 2025
Accepted: July 25, 2025
Published online: September 15, 2025
Processing time: 153 Days and 11.3 Hours

Abstract

BACKGROUND

The National Comprehensive Cancer Network guidelines recommend adjuvant chemotherapy (ACT) for patients with stage II colon cancer who have undergone curative surgery when fewer than 12 lymph nodes (LNs) are retrieved. This study seeks to further examine the requirement for ACT in individuals who had 12 or more LNs harvested.

AIM

To investigate if stage II colon cancer patients with 12 or more LNs retrieved benefit from ACT.

METHODS

This retrospective cohort study included individuals diagnosed with stage II colon cancer who underwent surgery between 2008 and 2017 from the Surveillance, Epidemiology, and End Results (SEER) registry and a Chinese multicenter database. All patients had at least 12 LNs retrieved. The key endpoint was overall survival (OS). Cox regression analysis was performed to assess independent OS predictors. Propensity score matching controlled for confounders, and Kaplan-Meier analysis evaluated the impact of ACT on survival.

RESULTS

A total of 32742 patients with stage II colon cancer from the SEER cohort and 3153 patients from the Chinese cohort were included. The average number of LNs retrieved was 20.0 (15.0, 26.0) in the SEER cohort and 18.0 (15.0, 22.0) in the Chinese cohort. No-ACT remained an independent risk factor in both cohorts (hazard ratio = 1.589, 95% confidence interval: 1.485-1.700 and hazard ratio = 1.865, 95% confidence interval: 1.465-2.375, respectively). In the SEER cohort, patients in the ACT group consistently demonstrated better 5-year OS rates both before and after propensity score matching (79.4% vs 66.1% and 79.4% vs 69.4%, both P < 0.0001). Similarly, these findings were further validated in the Chinese cohort (91.2% vs 82.1% and 90.0% vs 82.8%, both P < 0.0001). ACT improved prognosis even in T3 and grade 1/2 patients.

CONCLUSION

This research, based on two large population-based cohorts, demonstrates that stage II colon cancer patients with 12 or more LNs retrieved can still benefit from ACT.

Keywords: Stage II; Colon cancer; Lymph nodes; Chemotherapy; Prognosis

Core Tip: No adjuvant chemotherapy (ACT) continues to be a significant independent predictor for patients with stage II colon cancer who have 12 or more lymph nodes (LNs) removed. Even among these patients with T3 stage and grade 1/2, ACT still leads to improved prognosis. Based on two large-scale population-based cohorts and the propensity score matching method, we validated the generalizability and reliability of these findings. This research confirms that patients with adequate LNs retrieval (≥ 12 LNs) can still benefit from ACT, which is expected to provide valuable insights and further guide clinical practice in the management of colorectal carcinoma.