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Previous Volume 344:1196-1206 April 19, 2001 Number 16 Next

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ABSTRACT

Background Adjuvant chemotherapy improves survival among patients with stage III colon cancer, but no reliable molecular predictors of outcome have been identified.

Methods We evaluated loss of chromosomal material (also called loss of heterozygosity or allelic loss) from chromosomes 18q, 17p, and 8p; cellular levels of p53 and p21^WAF1/CIP1 proteins; and microsatellite instability as molecular markers. We analyzed tumor tissue from 460 patients with stage III and high-risk stage II colon cancer who had been treated with various combinations of adjuvant fluorouracil, leucovorin, and levamisole to determine the ability of these markers to predict survival.

Results Loss of heterozygosity at 18q was present in 155 of 319 cancers (49 percent). High levels of microsatellite instability were found in 62 of 298 tumors (21 percent), and 38 of these 62 tumors (61 percent) had a mutation of the gene for the type II receptor for transforming growth factor 1 (TGF-1). Among patients with microsatellite-stable stage III cancer, five-year overall survival after fluorouracil-based chemotherapy was 74 percent in those whose cancer retained 18q alleles and 50 percent in those with loss of 18q alleles (relative risk of death with loss at 18q, 2.75; 95 percent confidence interval, 1.34 to 5.65; P=0.006). The five-year survival rate among patients whose cancer had high levels of microsatellite instability was 74 percent in the presence of a mutated gene for the type II receptor for TGF-1 and 46 percent if the tumor did not have this mutation (relative risk of death, 2.90; 95 percent confidence interval, 1.14 to 7.35; P=0.03).

Conclusions Retention of 18q alleles in microsatellite-stable cancers and mutation of the gene for the type II receptor for TGF-1 in cancers with high levels of microsatellite instability point to a favorable outcome after adjuvant chemotherapy with fluorouracil-based regimens for stage III colon cancer.

Source Information

From the Division of Gastrointestinal–Liver Pathology, Department of Pathology (T.W., T.-T.W., T.U., R.S., S.R.H.), and the Oncology Center (S.R.H.), Johns Hopkins University School of Medicine, Baltimore; the Department of Biostatistical Science, Dana–Farber Cancer Institute, Boston (P.J.C.); the Hematology–Oncology Department, University of Pennsylvania Cancer Center, Philadelphia (D.G.H.); the Division of Hematology–Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago (A.B.B.); the Division of Pathology and Laboratory Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.R.H.); and the Eastern Cooperative Oncology Group, Brookline, Mass. (P.J.C., D.G.H., A.B.B., S.R.H.).

Address reprint requests to Dr. Hamilton at the Division of Pathology and Laboratory Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 85, G1.3754, Houston, TX 77030.

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