What is the 5-year survival rate for a patient with stage II colon cancer, vascular invasion, and no lymph node involvement, after surgical resection?

5-Year Survival Rate for Stage II Colon Cancer with Vascular Invasion

For a patient with stage II colon cancer, vascular invasion, and no lymph node involvement after surgical resection, the 5-year survival rate is approximately 68-83% with surgery alone, but the presence of vascular invasion as a high-risk feature significantly worsens this prognosis and warrants consideration of adjuvant chemotherapy to improve outcomes. 1

Baseline Survival Expectations

The overall 5-year disease-free survival rate for stage II colon cancer after surgical resection ranges from 68-83% with surgery alone. 1 More specifically:

• Stage IIA (T3) disease: 84.7% 5-year survival 1
• Stage IIB (T4) disease: 72.2% 5-year survival 1

However, these figures represent heterogeneous populations and do not account for specific high-risk features like vascular invasion.

Impact of Vascular Invasion on Prognosis

Vascular (lymphovascular) invasion is a well-established high-risk feature that significantly worsens prognosis in stage II colon cancer. 1, 2, 3

• Lymphovascular invasion is associated with a 5.2-fold increased risk of lymph node metastasis and recurrence 3
• In a multivariate analysis of stage II patients, vascular invasion was an independent predictor of postoperative early relapse (P = 0.029) 4
• The presence of vascular invasion increases the risk of recurrence to levels approaching 40-50%, similar to stage III disease 1

Survival Data for High-Risk Stage II Disease

When multiple high-risk features are present (including vascular invasion), survival outcomes deteriorate substantially:

• Patients with two or more high-risk factors have a 5-year disease-free survival of 74.8% compared to 87.3% for those with only one risk factor 1, 2
• A population-based study showed that stage II patients with vascular invasion who received adjuvant chemotherapy had improved survival (HR = 0.62,95% CI [0.39-0.98], P = 0.043) compared to surgery alone 5

Additional Prognostic Considerations

Your patient's prognosis depends on whether other high-risk features are present: 1, 2

• Fewer than 12 lymph nodes examined (additional high-risk feature that worsens prognosis) 1, 4
• T-stage: T3 (stage IIA) versus T4 (stage IIB/IIC) - T4 tumors have substantially worse outcomes 1
• Tumor grade: Poorly or undifferentiated histology (5.1-fold increased risk) 3
• Perineural invasion (independent risk factor for recurrence) 3
• Tumor budding grade BD3 (≥10 buds) 1

Clinical Implications for This Patient

The presence of vascular invasion classifies this patient as high-risk stage II, placing them in a category where adjuvant chemotherapy may be offered to improve survival outcomes beyond the baseline 68-83% expected with surgery alone. 1, 2

The ASCO guideline specifically states that adjuvant chemotherapy may be offered to patients with stage IIA (T3) colon cancer with high-risk features including lymphovascular invasion, with the understanding that benefits may outweigh harms. 1 If this patient has stage IIB/IIC (T4) disease with vascular invasion, adjuvant chemotherapy should be offered with discussion of potential benefits and risks. 1

Important Caveats

• Microsatellite instability (MSI) status matters: If the tumor is MSI-high/dMMR, fluoropyrimidine-based chemotherapy should NOT be routinely offered regardless of vascular invasion, as harms may outweigh benefits in this molecular subtype 1, 2, 6
• The absolute survival benefit from adjuvant chemotherapy in stage II disease is modest (not more than 5% on average), so the decision requires careful shared decision-making weighing toxicity risks against potential benefit 1
• The number of high-risk features present (vascular invasion plus others) substantially impacts the strength of the recommendation for chemotherapy 1, 2