Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2024; 16(5): 1869-1877
Published online May 15, 2024. doi: 10.4251/wjgo.v16.i5.1869
Clinical outcome and prognostic factors of T4N0M0 colon cancer after R0 resection: A retrospective study
Bang Liu, Zhao-Xiong Zhang, Xin-Yang Nie, Wei-Lin Sun, Yong-Jia Yan, Wei-Hua Fu
Bang Liu, Zhao-Xiong Zhang, Xin-Yang Nie, Wei-Lin Sun, Yong-Jia Yan, Wei-Hua Fu, Department of General Surgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
Co-first authors: Bang Liu and Zhao-Xiong Zhang.
Co-corresponding authors: Yong-Jia Yan and Wei-Hua Fu.
Author contributions: Liu B and Zhang ZX contributed equally to this work; Liu B, Zhang ZX, Yan YJ and Fu WH designed the research study; Liu B, Zhang ZX, Nie XY and Sun WL performed the research; Liu B and Nie XY contributed analytic tools; Liu B and Zhang ZX analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Supported by Health Science and Technology Project of Tianjin Health Commission, No. ZC20190; Tianjin Key Medical Discipline (Specialty) Construction Project, No. TJYXZDXK-005A; and Tianjin Medical University Clinical Research Fund, No. 22ZYYLCCG04.
Institutional review board statement: The study was reviewed and approved by The Ethical Committee of Tianjin Medical University General Hospital, No. IRB2023-WZ-205.
Informed consent statement: Informed oral consent was obtained from the patients for the release of clinical data involved in this study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at tjmughgs_fwh@163.com. Participants gave informed oral consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Hua Fu, MD, PhD, Professor, Surgeon, Teacher, Department of General Surgery, Tianjin Medical University General Hospital, Tianjin Medical University, No. 154 Anshan Road, Tianjin 300052, China. tjmughgs_fwh@163.com
Received: January 15, 2024
Peer-review started: January 15, 2024
First decision: February 5, 2024
Revised: February 14, 2024
Accepted: March 28, 2024
Article in press: March 28, 2024
Published online: May 15, 2024
Processing time: 115 Days and 6.7 Hours
Abstract
BACKGROUND

Paradoxically, patients with T4N0M0 (stage II, no lymph node metastasis) colon cancer have a worse prognosis than those with T2N1-2M0 (stage III). However, no previous report has addressed this issue.

AIM

To screen prognostic risk factors for T4N0M0 colon cancer and construct a prognostic nomogram model for these patients.

METHODS

Two hundred patients with T4N0M0 colon cancer were treated at Tianjin Medical University General Hospital between January 2017 and December 2021, of which 112 patients were assigned to the training cohort, and the remaining 88 patients were assigned to the validation cohort. Differences between the training and validation groups were analyzed. The training cohort was subjected to multivariate analysis to select prognostic risk factors for T4N0M0 colon cancer, followed by the construction of a nomogram model.

RESULTS

The 3-year overall survival (OS) rates were 86.2% and 74.4% for the training and validation cohorts, respectively. Enterostomy (P = 0.000), T stage (P = 0.001), right hemicolon (P = 0.025), irregular review (P = 0.040), and carbohydrate antigen 199 (CA199) (P = 0.011) were independent risk factors of OS in patients with T4N0M0 colon cancer. A nomogram model with good concordance and accuracy was constructed.

CONCLUSION

Enterostomy, T stage, right hemicolon, irregular review, and CA199 were independent risk factors for OS in patients with T4N0M0 colon cancer. The nomogram model exhibited good agreement and accuracy.

Keywords: T4N0M0 colon cancer; Prognosis; Multivariate analysis; Nomogram; Colon cancer

Core Tip: Paradoxically, patients with T4N0M0 (stage II, no lymph node metastasis) colon cancer have a worse prognosis than those with T2N1-2M0 (stage III). However, no previous report has addressed this issue. A total of 200 patients underwent radical surgery with pTNM “T4N0M0” were enrolled in this study. The clinical data and outcomes of the 200 patients were analyzed. We confirmed enterostomy, T stage, right hemicolon, irregular review, carbohydrate antigen 199 were independent risk factors of overall survival by using multivariate analysis. A nomogram model based on these factors was established to predict the prognosis of patients with T4N0M0 colon cancer.