Integrated multiplex analysis of cell death regulators in stage II colorectal cancer suggests patients with 'persister' cell profiles fail to benefit from adjuvant chemotherapy.

Although there were no significant differences after adjustment for multiple testing, there was a weak trend for MMR-proficient patients to have high % cluster 2 or high % cluster 4 cells.

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Three significant clinical trials have been conducted in patients with stage II CRC, including the QUASAR clinical trial, which showed a 3.6% survival benefit within 2 years of surgery 27 ; the National Surgical Adjuvant Breast and Bowel Project (NSABP; studies C-01 to C-04), which compared surgery alone to chemotherapy in stage II and stage III colon cancer and found that chemotherapy decreased risk of recurrence regardless of risk status 28 ; and the phase III MOSAIC trial (Multicenter International Study of Oxaliplatin/5-FU/LV in the Adjuvant Treatment of Colon Cancer) showed a trend for better disease-free survival in patients with stage II colon cancer. 29 In a meta-analysis, 30 5-year disease-free survival was found to be 81.4% for patients with stage II colon cancer who underwent resection without adjuvant chemotherapy and 79.3% for patients receiving adjuvant chemotherapy.

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