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Correspondence |

Significance of Subclinical Tumor Spreading in Colorectal Cancer

M. Badruddoja, MD, FRCS, FRACS
Arch Surg. 2008;143(11):1133-1134. doi:10.1001/archsurg.143.11.1133.
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The article by Steinert et al1 in the February issue of the Archives about the effect of subclinical metastasis in distant sites on disease-free survival (DFS) in patients who had curative resections for colorectal cancer (CRC) is high-powered and credible. Their conclusion is that subclinical metastasis does not affect the overall survival (OS) or DFS in these patients. This 9-year study was very well designed.

The authors have studied this important subject in all stages of CRC. It is well known that stage II (with low and stable microsatellite instability), III, and IV diseases are advanced. In this group of patients, it is very likely that clinical and subclinical metastases will have little effect on DFS and OS, and as such this study has very little significance to clinicians. For stage I disease, however, this study is very significant.

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