Besides lung (1.61 million) and breast cancer (1.38 million), colorectal cancer (1.23 million) was one of the most commonly diagnosed malignancies in 2008 worldwide.1
In Europe, 436.000 new cases of colorectal cancer (CRC) were diagnosed in 2008 accounting for 13.6% of all diagnosed cancer.2
Moreover, CRC was the second most common cause of cancer death with 12.2% (n = 212.000) after lung cancer (19.9%) in the same year. Median age at diagnosis is about 65 years. During the last two decades, mortality from CRC decreased, potentially related to improved detection (screening and early diagnosis) and advances in treatment of the disease.3,4
Recent analyses support the hypothesis of a preventive effect of CRC-related death by polypectomy performed during screening colonoscopy.5
Primary treatment of localized colon cancer (about 75% of patients at diagnosis) is surgery. Whereas very early tumors (Tis or T1 N0 L0 G1 or G2) can be removed by local excision, standard approach for tumors > T1 is a wide local excision. Standardized pathologic assessment should include staging for depth of penetration (T), lymph node status (N), with a minimum of 12 nodes examined, resection margin status, grading (G), tumor type, tumor deposits, perineural growth, extramural invasion, and lymphovascular invasion. Beyond TNM, CRC is classified according to UICC (Union Internationale Contre le Cancer) stages and can be further stratified within lymph node negative stage II disease by the occurrence of clinicopathological risk factors (lymph nodes sampling <12, poorly differentiated tumor, vascular or lymphatic or perineural invasion, pT4 stage, and clinical presentation with intestinal occlusion or perforation) in high-risk (at least one risk factor) or low risk stage II.
There is significant variability in survival depending on pathological staging (). Whereas in stage I the overall recurrence rate is about 3.0%–4.6% with a median time to recurrence of 33 months, stage-specific relative 5-year survival is only about 27% for stage IIIC (T4 N2).6,7
In regard of the poor outcome of stage III and partly stage II disease after curative resection adjuvant chemotherapy, which can eradicate occult tumor cells that might have remained after surgery, is commonly administered.
Relative (disease-specific) 5 year-overall survival in patients irrespective of treatment received (r5yOSR: relative 5 year overall survival rate).
The aim of this article is to review the available data on adjuvant treatment with capecitabine for localized colon cancer, in particular prognostic and predictive markers. Data from published trials, reports, and abstracts presented at selected oncology association meetings (eg, American Society of Clinical Oncology [ASCO]) were reviewed.