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Staging Paradox and Discrepancy in Adjuvant Chemotherapy in Patients with T4N0, T1-2N1, and T3N1 Colon Cancer

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Abstract

Background

A survival paradox between T4N0 (stage IIB/C) and T3N1 (stage IIIB) colon cancer has been rarely reported. The indication and regimen of adjuvant chemotherapy are separately described in the guidelines. This study aimed to elucidate the prognostic factors and investigate proper adjuvant treatment in colon cancer patients at these stages.

Methods

Patients who underwent R0 resection for pathological T4N0 (n = 49), T1-2N1 (n = 31), or T3N1 (n = 82) colon cancer between 2008 and 2016 at a single institute were retrospectively reviewed. The clinicopathological characteristics, status of adjuvant chemotherapy, and oncologic outcomes of patients with T4N0 tumors were compared with those of patients with T1-2N1 and T3N1 tumors.

Results

The biological characteristics of T4N0 tumors were more aggressive compared with the characteristics of T1-2N1 tumors and were similar to those of T3N1 tumors. The usage rate of oxaliplatin as an adjuvant chemotherapy was significantly lower in T4N0 patients than in T1-2N1 and T3N1 patients. The rate of local recurrence was the highest in patients with T4N0 tumors, and the survival outcomes for patients with T4N0 tumors were significantly worse compared with those of T1-2N1 patients and were similar to those of T3N1 patients. A multivariate analysis revealed that lack of adequate use of oxaliplatin for adjuvant chemotherapy was the only prognostic factor.

Conclusions

T4N0 colon cancer had similar oncological characteristics and survival outcomes to T3N1 colon cancer. Systematic adjuvant chemotherapy, including oxaliplatin, should be incorporated into the therapy for T4N0 patients as well as T3N1 patients.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Hiroki Shimizu, Yoshiaki Kuriu, Tomohiro Arita, Jun Kiuchi, Yusuke Yamamoto, Hirotaka Konishi, Ryo Morimura, Atsushi Shiozaki, Hisashi Ikoma, Takeshi Kubota, Hitoshi Fujiwara, Kazuma Okamoto & Eigo Otsuji

Authors
  1. Hiroki Shimizu
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  2. Yoshiaki Kuriu
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  3. Tomohiro Arita
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  4. Jun Kiuchi
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  5. Yusuke Yamamoto
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  6. Hirotaka Konishi
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  12. Kazuma Okamoto
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  13. Eigo Otsuji
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Corresponding author

Correspondence to Hiroki Shimizu.

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The authors declare that they have no conflicts of interest

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Informed consent was obtained from all individual participants included in the study. This study was approved by the ethics committee of the Kyoto Prefectural University of Medicine, and written informed consent was obtained from all patients for the use of their data for clinical studies.

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Shimizu, H., Kuriu, Y., Arita, T. et al. Staging Paradox and Discrepancy in Adjuvant Chemotherapy in Patients with T4N0, T1-2N1, and T3N1 Colon Cancer. World J Surg 45, 1561–1568 (2021). https://doi.org/10.1007/s00268-021-05973-0

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  • DOI: https://doi.org/10.1007/s00268-021-05973-0

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