Japanese Approach to colon cancer and the Outcome

Dep. of Surgical OncologyTokyo Medical and Dental University

Kenichi Sugihara

Overall Survival

Colon Ca (n=3061)

P = 0.0033

year

Surv

ival

rate

0 1 2 3 4 5 6 7 8 9 100.0

0.2

0.4

0.6

0.8

1.0

Rectal Ca (n=1393)

84.6%

80.6%

1997 〜 2000 in 18 hospitals

median follow-up time: 71 months

OS; Stage II Colon Cancer

N 5Y-OS

800, 93.5%

914, 88.8%

195, 81.7%

92, 82.1%

128, 91.3%

743, 77.4%

189, 55.5%P<0.0001

Stage I

Stage IIA

Stage IIB

Stage IIC

Stage IIIA

Stage IIIB

Stage IIIC

year

Surv

ival

rate

0 1 2 3 4 5 6 7 8 9 100.0

0.2

0.4

0.6

0.8

1.0TNM 7th ed.

N 5Y-OS

800, 93.5%

914, 88.8%

195, 81.7%

92, 82.1%

128, 91.3%

743, 77.4%

189, 55.5%P<0.0001

Stage I

Stage IIA

Stage IIB

Stage IIC

Stage IIIA

Stage IIIB

Stage IIIC

year

Surv

ival

rate

0 1 2 3 4 5 6 7 8 9 100.0

0.2

0.4

0.6

0.8

1.0

TNM 7th ed.

OS; Stage III Colon Cancer

Randomized Studies of Adjuvant Chemotherapy in Japan

Trials Regimen Duration(months)

Stage No. of Pts

Enrolment

JCOG0205

5FU+l-LV vs. UFT+LV

６ Stage IIIColon cancer

1101 completed in Nov. 2006

JCOG0910

CapecitabineVs. S-1

６ Stage IIIColon cancer

1550 started in March 2010

ACTS-CC UFT+LVVs. S-1

６ Stage IIIColon cancer

1530 completed in June 2009

SACURA UFT vs. surgery alone

12 Stage IIColon cancer

2024 completed in July 2010

ACTS-CC 　 02

UFT+LVvs. SOX

６ anyTN2Colon cancer

1200 started in April 2010

ACTS-RC UFT vs. S-1 12 Stage II, IIIRectal cancer

961 completed in March 2009

JFMC37 Capecitabine 6 vs 12 Stage IIIColon cancer

1306 completed in Dec. 2009

UFT/LV vs. 5FU/LVJCOG 0205: Phase III non-inferiority study

Stage IIIColon Cancer

(n=1,101)R

UFT/LV (oral) (n=551)

5FU/LV (RPMI) (n=550)

Primary endpoint ： DFSSecondary endpoint ： OS, Safety

Feb. 2003 - Oct. 2006

3 yrs 4 yrs 5 yrs0.5

0.550.6

0.650.7

0.750.8

0.850.9

0.951

3 yrs 4 yrs 5 yrs0.5

0.6

0.7

0.8

0.9

1

78.3 % 75.0 % 73.8 %

90.3 %94.2%88.2 %

Disease Free Survival Overall Survival

Mortality/Morbidity

Surgery of Colon Cancer

No. Mortality

118,426 0.7%

rt. colectomy/hemicolectomy

No.

39,386

Anastomotic Leakage

1.5%high anterior resection 17,418 2.5%

National Survey of Digestive Surgery by the Japanese Society of Gastroenterological Surgery 1,191,643 surgeries between 2006 and 2008

high/low anterior resection 55,557 0.34%

APR 11908 0.7%

Differences of Colon Cancer Carebetween Japan and Western

Scope of LN dissection

Histopathological examination of resected specimens

Surveillance after surgery

Strategy for liver metastasis

Medical care system/Medical insurance system

JSCCR

Thank you for your attention