Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2016; 22(29): 6726-6735
Published online Aug 7, 2016. doi: 10.3748/wjg.v22.i29.6726
Smaller tumor size is associated with poor survival in T4b colon cancer
Ben Huang, Yang Feng, Shao-Bo Mo, San-Jun Cai, Li-Yong Huang
Ben Huang, Yang Feng, Shao-Bo Mo, San-Jun Cai, Li-Yong Huang, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 20032, China
Author contributions: Huang B and Feng Y contributed equally to this work; Cai SJ and Huang LY are responsible for the study conception and design; Mo SB acquired the data; Huang B and Feng Y analyzed the data and wrote the manuscript.
Institutional review board statement: The study was reviewed and approved by the Fudan University Shanghai Cancer Center Ethical Committee and Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Li-Yong Huang, MD, PhD, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai 20032, China. hly_981@163.com
Telephone: +86-21-6417 4774 Fax: +86-21-6417 4774
Received: March 24, 2016
Peer-review started: March 25, 2016
First decision: May 12, 2016
Revised: May 25, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: August 7, 2016
Abstract

AIM: To hypothesize that in patients with colon cancer showing heavy intestinal wall invasion without distant metastasis (T4bN0-2M0), small tumor size would correlate with more aggressive tumor behaviors and therefore poorer cancer-specific survival (CSS).

METHODS: We analyzed T4bN0-2M0 colon cancer patients in the Surveillance, Epidemiology and End Results (SEER) database. A preliminary analysis of T4bN0-2M0 colon cancer patients at the Fudan University Shanghai Cancer Center is also presented.

RESULTS: A total of 1734 T4bN0-2M0 colon cancer patients from the SEER database were included. Kaplan-Meier analysis revealed decreasing CSS with decreasing tumor size (P < 0.001). Subgroup analysis showed a significant association between poorer CSS with smaller tumor size in T4bN0 patients (P = 0.024), and a trend of association in T4bN1 (P = 0.182) and T4bN2 patients (P = 0.191). Multivariate analysis identified tumor size as an independent prognostic factor for CSS in T4bN0-2M0 patients (P = 0.024). Preliminary analysis of Fudan University Shanghai Cancer Center samples suggested the 5-year CSS was 50.0%, 72.9% and 77.1% in patients with tumors ≤ 4.0 cm, 4.0-7.0 cm and ≥ 7.0 cm.

CONCLUSION: Smaller tumor size is associated with poorer CSS in the T4bN0-2M0 subset of colon cancer, particularly in the T4bN0M0 subgroup.

Keywords: Survival, Colon cancer, Tumor size, T4b colon cancer, Locally advanced colon cancer

Core tip: In contrast to the association of larger tumor size with poor cancer-specific survival (CSS) in colon cancer patients overall, this study suggested that smaller tumor size was associated with poor CSS in the T4bN0-2M0 subpopulation, particularly in the T4bN0M0 subgroup.