Revisiting the Survival Paradox Between Stage IIB/C and IIIA Colon Cancer

Overview

Journal Sci Rep

Specialty Science

Date 2024 Sep 28

PMID 39333782

Authors

Cheng Yu

Zhiliang Shi

Guoqiang Zhou

Xu Chang

Affiliations

Soon will be listed here.

Abstract

Patients with stage IIB/C (T4a-bN0) colon cancer often exhibit worse survival rates compared to those with stage IIIA (T1-2N1, T1N2a) colon cancer. This study re-evaluates the survival paradox using the latest Surveillance, Epidemiology, and End Results (SEER) data (released on April 17, 2024) to inform potential revisions to the staging criteria. Utilizing SEER data with 8th edition TNM staging criteria, 4692 colon cancer patients diagnosed between 2018 and 2021 were analyzed with chi-square test. Cox regression and Kaplan-Meier survival analysis were employed to assess factors associated with cancer-specific survival (CSS) and overall survival (OS). The 3-year CSS rates for stage IIB and IIC were 73.1% and 70.3%, respectively, whereas stage IIIA had a substantially higher CSS rate of 91% (P < 0.001). Similarly, the OS rates were 64.9% and 63.0% for stage IIB and IIC, respectively, compared to 83.1% for stage IIIA (P < 0.001). Multivariate analyses revealed stage IIIA patients had significantly lower risks of cancer-specific mortality (hazard ratio (HR) = 0.374, 95% CI: 0.296-0.473, P < 0.001) and overall mortality (HR = 0.575, 95% CI: 0.483-0.685, P < 0.001) compared to stage IIB patients. The upcoming 9th edition of the AJCC staging system should address this paradox by integrating advanced diagnostic markers and emphasizing the aggressive biology of T4 tumor, providing more accurate prognostic information and guiding more effective treatment strategies for colon cancer patients.

References

Chu Q, Zhou M, Medeiros K, Peddi P, Kavanaugh M, Wu X . Poor survival in stage IIB/C (T4N0) compared to stage IIIA (T1-2 N1, T1N2a) colon cancer persists even after adjusting for adequate lymph nodes retrieved and receipt of adjuvant chemotherapy. BMC Cancer. 2016; 16:460. PMC: 4944507. DOI: 10.1186/s12885-016-2446-3. View

OConnell M, Lavery I, Yothers G, Paik S, Clark-Langone K, Lopatin M . Relationship between tumor gene expression and recurrence in four independent studies of patients with stage II/III colon cancer treated with surgery alone or surgery plus adjuvant fluorouracil plus leucovorin. J Clin Oncol. 2010; 28(25):3937-44. PMC: 2940392. DOI: 10.1200/JCO.2010.28.9538. View

Lee J, Yu M, Kim S, Lee J, Sung S, Jeong B . Pathologic Staging Inconsistency Between ypT4N0 (stage II) and ypT1-2N1 (stage III) After Preoperative Chemoradiotherapy and Total Mesorectal Excision in Rectal Cancer: A Multi-Institutional Study. Clin Colorectal Cancer. 2019; 18(1):e130-e139. DOI: 10.1016/j.clcc.2018.11.003. View

Zheng P, Xu G, Qin Z, Zhou S, Huang H, Ma D . The Causes Behind the Survival Paradox in Non-Metastatic Colorectal Cancer Patients and its Impact on the Treatment Regimen: A Retrospective Cohort Study. Surgery. 2024; 176(2):310-318. DOI: 10.1016/j.surg.2024.03.043. View

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

Gray R, Quirke P, Handley K, Lopatin M, Magill L, Baehner F . Validation study of a quantitative multigene reverse transcriptase-polymerase chain reaction assay for assessment of recurrence risk in patients with stage II colon cancer. J Clin Oncol. 2011; 29(35):4611-9. DOI: 10.1200/JCO.2010.32.8732. View

Webber A, Gupta P, Marcello P, Stain S, Abelson J . Lymph node retrieval colon cancer: Are we making the grade?. Am J Surg. 2023; 226(4):477-484. DOI: 10.1016/j.amjsurg.2023.05.035. View

Nagtegaal I, Knijn N, Hugen N, Marshall H, Sugihara K, Tot T . Tumor Deposits in Colorectal Cancer: Improving the Value of Modern Staging-A Systematic Review and Meta-Analysis. J Clin Oncol. 2016; 35(10):1119-1127. DOI: 10.1200/JCO.2016.68.9091. View

Roth A, Delorenzi M, Tejpar S, Yan P, Klingbiel D, Fiocca R . Integrated analysis of molecular and clinical prognostic factors in stage II/III colon cancer. J Natl Cancer Inst. 2012; 104(21):1635-46. DOI: 10.1093/jnci/djs427. View

10.

Compton C, Fenoglio-Preiser C, Pettigrew N, Fielding L . American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer. 2000; 88(7):1739-57. DOI: 10.1002/(sici)1097-0142(20000401)88:7<1739::aid-cncr30>3.0.co;2-t. View

11.

Duraes L, Steele S, Valente M, Abdelaziz T, Connelly T, Kessler H . The use of laparoscopy for T4a and T4b colon cancer: are we playing with fire?. Surg Endosc. 2023; 37(7):5679-5686. DOI: 10.1007/s00464-023-09944-5. View

12.

Simoes P, Fernandes G, Costeira B, Machete M, Baptista C, N Silva D . Lymph node yield in the pathological staging of resected nonmetastatic colon cancer: The more the better?. Surg Oncol. 2022; 43:101806. DOI: 10.1016/j.suronc.2022.101806. View

13.

Li H, Fu G, Wei W, Huang Y, Wang Z, Liang T . Re-Evaluation of the Survival Paradox Between Stage IIB/IIC and Stage IIIA Colon Cancer. Front Oncol. 2020; 10:595107. PMC: 7708319. DOI: 10.3389/fonc.2020.595107. View

14.

Chu Q, Li T, Hsieh M, Yi Y, Gibbs J, Sahawneh J . Survival paradox between stage IIB/C and stage IIIA colon cancer: is it time to revise the American Joint Committee on Cancer TNM system?. Surg Endosc. 2024; 38(5):2857-2870. DOI: 10.1007/s00464-024-10723-z. View

15.

Edge S, Compton C . The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17(6):1471-4. DOI: 10.1245/s10434-010-0985-4. View

16.

Siegel R, Miller K, Wagle N, Jemal A . Cancer statistics, 2023. CA Cancer J Clin. 2023; 73(1):17-48. DOI: 10.3322/caac.21763. View

17.

Kim M, Jeong S, Choi S, Ryoo S, Park J, Park K . Survival paradox between stage IIB/C (T4N0) and stage IIIA (T1-2N1) colon cancer. Ann Surg Oncol. 2014; 22(2):505-12. DOI: 10.1245/s10434-014-3982-1. View

18.

Chu Q, Zhou M, Medeiros K, Peddi P . Positive surgical margins contribute to the survival paradox between patients with stage IIB/C (T4N0) and stage IIIA (T1-2N1, T1N2a) colon cancer. Surgery. 2016; 160(5):1333-1343. DOI: 10.1016/j.surg.2016.05.028. View

19.

OConnell J, Maggard M, Ko C . Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004; 96(19):1420-5. DOI: 10.1093/jnci/djh275. View

20.

Amin M, Greene F, Edge S, Compton C, Gershenwald J, Brookland R . The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017; 67(2):93-99. DOI: 10.3322/caac.21388. View