Optimization of the tactics of adjuvant chemotherapy in patients with colon cancer taking into account clinical and morphological characteristics

Background. Colorectal cancer (CRC) remains an urgent problem in modern oncology. With the introduction of CRC screening, early stages of disease are more often detected and, accordingly, adjuvant chemotherapy is prescribed. Before the appointment of adjuvant chemotherapy, the known factors of a negative prognosis are taken into account - a low degree of cell differentiation, the presence of lymphovascular/perineural invasion, R+, surgery in conditions of intestinal obstruction/peritonitis, surgery with an inadequate volume of lymphadenectomy (less than 12 lymph nodes studied, CEA>2.35 ng/ml after surgery), but none of these factors are universal. At the moment, it is interesting to study new prognostic factors and their influence on relapse-free survival in patients with CRC. Objective. Optimization of adjuvant chemotherapy and an increase in relapse-free survival in patients with CRC by analyzing their clinical and morphological characteristics. Methods. The study included 113 patients: 53 with stage II colon cancer (group A) and 60 with stage III colon cancer (group B). The median follow-up was 60 months. From the start of follow-up, distant metastases were revealed in patients at various times, as a result of which all patients in groups A and B were divided into subgroups. In patients of subgroup 1 of each group, no distant metastases were recorded for 60 months using standard observational methods; in patients of subgroup 2, the progression of the process in the form of the appearance of distant metastases was recorded. Further, the clinical characteristics of the patient (gender, age, tumor localization, the nature of the surgical treatment performed) and the morphological characteristics of the tumor were assessed, for which all histological blocks of patients were additionally examined for the CXCR4chemokine receptor expression, CCR10, Ki-67 proliferation index, and KRAS mutation. Results. The median relapse-free period is significantly lower in the subgroups of patients with distant metastases (subgroup 2), where additional factors of negative prognosis were revealed - high CXCR4 chemokine receptor expression in tumor tissue and low Ki-67 proliferation index. Conclusion. Assessment of the combination of clinical and morphological characteristics of patients with CRC will help us to optimize adjuvant treatment.

colon cancer, adjuvant chemotherapy, CXCR4 chemokine receptor, prognostic factors