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Inclusion of Vasculature-Related Variables in the Dukes Staging System of Colon Cancer

Authors' Affiliations: ¹ Departments of Pathology, and Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis, Greece; ² Department of Pathology, Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital; and ³ Cancer Research UK, Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom

Requests for reprints: Michael I. Koukourakis, Department of Radiotherapy/Oncology, Democritus University of Thrace, P.O. Box 12, Alexandroupolis 68100, Greece. Phone: 30-69324-80808; Fax: 30-25510-30349; E-mail: targ{at}her.forthnet.gr.

Purpose: The Dukes stage is used to stratify colorectal cancer patients into groups of different prognosis and need of adjuvant radiotherapy and chemotherapy. However, 80% of patients with Dukes stage C colorectal cancer receive cytotoxic therapy without any expected benefit, for such patients would either not relapse without adjuvant therapy or they would inevitably do so because of tumor resistance to the available regimens. On the other hand, as 20% of Dukes stage B patients would relapse after surgery, adjuvant therapy could improve their survival. Improvement of the Dukes stage predictive accuracy is necessary to better assign patients for adjuvant therapies, especially nowadays when antiangiogenic agents are being incorporated in the clinical practice.

Patients and Methods: In this study, we examined the prognostic role of Dukes staging system in parallel with three vasculature-related variables (vascular invasion, tumor angiogenic activity, and vascular survival ability) in a series of 130 stage B/C patients with colorectal cancer treated with surgery alone (without adjuvant radiotherapy or chemotherapy).

Results: Inclusion of vasculature-related variables in the Dukes staging system significantly improved the prognostic categorization of patients, identifying subgroups of B-stage and C-stage patients with an up to 40% and 60% 5-year survival difference, respectively.

Conclusions: Preliminary results show that the prognostic value of Dukes staging system is significantly improved after taking into account vasculature-related variables, which may be useful in stratifying patients for adjuvant therapies, highlighting also subgroups that may benefit the most from antiangiogenic agents.

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