Is the Tegafur/uracil and Leucovorin Adjuvant Chemotherapy Overused in Low-risk Group Stage II Colorectal Cancer Patients?

Purpose. Colorectal cancer is one of the most common cancers and the third leading cause of cancer-related death in Taiwan. Because of the nationwide biennial fecal immunochemical screening, the number of colorectal cancer cases detected at an early stage is increasing. According to the National comprehensive cancer network (NCCN) clinical practice guidelines, adjuvant chemotherapy is suggested for patients with high-risk group stage II colorectal cancer; research in the low-risk group stage II colorectal cancer has been less specific. We aimed to review our hospital database to evaluate the effect of uracil-tegafur (UFT) and leucovorin adjuvant chemotherapy on low-risk group stage II colorectal cancer patients. Materials and Methods. Between January 2004 and August 2009, 1273 stage II colorectal cancer patients underwent standard curative operations at the Linkou and Keelung Branch of Chang Gung Memorial Hospital in Taiwan. After excluding the patients with early recurrence within 6 months after the operation, and those who received intravenous adjuvant chemotherapy, the remaining 1107 patients were enrolled in the study. After analyzing the pathological and clinical characteristics of the patients, 515 were identified to have low-risk group stage II colorectal cancer. All patients in this group were followed up for at least 5 years postoperatively or until the date of patient death. Statistical analysis was performed with SPSS ver. 20. Results. In our database, patients in the high-risk group (n = 592) had significantly worse overall survival and 5-year disease-free survival compared to those in the low-risk group (n = 515). In the low-risk group stage II colorectal cancer patients, 70 patients received UFT and leucovorin adjuvant chemotherapy, while 445 patients did not receive adjuvant chemotherapy. Comparing the two groups revealed that UFT and leucovorin adjuvant chemotherapy did not improve the overall survival or 5-year disease- free survival in the low-risk group stage II colorectal cancer patients. Conclusion. Our data showed that low-risk group stage II colorectal cancer patients who received the UFT and leucovorin adjuvant chemotherapy might be overtreated. We should aim to avoid exposing these patients to the side effects of unnecessarily administered chemotherapy, and control its impact on the economy.