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Nomograms to predict cancer-specific mortality in colon adenocarcinoma with different types of villous architecture

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The role of villous architecture in the prognosis of colon adenocarcinoma remains unclear. This study aimed to investigate the prognostic factors of colon adenocarcinoma with different types of villous architecture and to establish nomograms for predicting cancer-specific mortality.

Methods

This retrospective study included 10,427 patients with colon adenocarcinoma arising in adenomas with villous architectures. The patients were stratified into the tubulovillous adenocarcinoma cohort and villous adenocarcinoma cohort. The prognostic risk factors, which were incorporated into nomograms for survival prediction, were determined by the log-rank test and Cox hazard models. The Harrell’s Concordance Index (C-index) and calibration curve were utilized to evaluate the prediction accuracy.

Results

The pathological type of villous architecture was independently associated with the mortality of the entire population. Age, race, tumor size, T/N/M stage, and chemotherapy were independent risk factors of mortality in both cohorts. Interestingly, tumor differentiation was a prognostic factor for tubulovillous adenocarcinoma rather than villous adenocarcinoma, while the retrieved lymph node number was a prognostic factor for villous adenocarcinoma rather than tubulovillous adenocarcinoma. Survival analysis showed that the mortality rate of villous adenocarcinoma was higher than that of tubulovillous adenocarcinoma (HR 1.361, P < 0.001). We then established nomograms to predict the mortality of both cohorts and found excellent discrimination and predictive accuracy (C-index 0.842 and 0.821).

Conclusion

Villous architecture is a determinant of colon adenocarcinoma outcomes, which might prompt reports of villous architecture in colon adenocarcinoma specimens by pathologists. Our population-based nomograms could be useful for predicting the survival of patients with colon adenocarcinoma and guiding individualized treatments.

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Availability of data and material

The dataset is available on an online repository (https://seer.cancer.gov/seerstat/).

Code availability

The R script is available from the corresponding author when required for specific reasons.

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA: a cancer journal for clinicians 65(2):87–108. https://doi.org/10.3322/caac.21262

  2. Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA: a cancer journal for clinicians 70(1):7–30. https://doi.org/10.3322/caac.21590

  3. Yadamsuren EA, Nagy S, Pajor L, Lacza A, Bogner B (2012) Characteristics of advanced- and non advanced sporadic polypoid colorectal adenomas: correlation to KRAS mutations. Pathology oncology research : POR 18(4):1077–84. https://doi.org/10.1007/s12253-012-9547-3

  4. Strul H, Kariv R, Leshno M, Halak A, Jakubowicz M, Santo M et al (2006) The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40–80 years. The American journal of gastroenterology 101(2):255–62. https://doi.org/10.1111/j.1572-0241.2006.00430.x

  5. Sillars-Hardebol AH, Carvalho B, de Wit M, Postma C, Delis-van Diemen PM, Mongera S et al (2010) Identification of key genes for carcinogenic pathways associated with colorectal adenoma-to-carcinoma progression. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine 31(2):89–96. https://doi.org/10.1007/s13277-009-0012-1

  6. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. The New England journal of medicine 329(27):1977–81. https://doi.org/10.1056/nejm199312303292701

  7. Brenner H, Chang-Claude J, Jansen L, Seiler CM, Hoffmeister M (2012) Role of colonoscopy and polyp characteristics in colorectal cancer after colonoscopic polyp detection: a population-based case-control study. Annals of internal medicine 157(4):225–32. https://doi.org/10.7326/0003-4819-157-4-201208210-00002

  8. van Heijningen EM, Lansdorp-Vogelaar I, Kuipers EJ, Dekker E, Lesterhuis W, Ter Borg F, et al (2013) Features of adenoma and colonoscopy associated with recurrent colorectal neoplasia based on a large community-based study. Gastroenterology 144(7):1410–8. https://doi.org/10.1053/j.gastro.2013.03.002

  9. Fairley KJ, Li J, Komar M, Steigerwalt N, Erlich P (2014) Predicting the risk of recurrent adenoma and incident colorectal cancer based on findings of the baseline colonoscopy. Clinical and translational gastroenterology 5(12):e64. https://doi.org/10.1038/ctg.2014.11

  10. van Enckevort CC, de Graaf AP, Hollema H, Sluiter WJ, Kleibeuker JH, Koornstra JJ (2014) Predictors of colorectal neoplasia after polypectomy: based on initial and consecutive findings. The Netherlands journal of medicine 72(3):139–45

  11. Bjerrum A, Milter MC, Andersen O, Fischer A, Lynge E (2015) Risk stratification and detection of new colorectal neoplasms after colorectal cancer screening with faecal occult blood test: experiences from a Danish screening cohort. European journal of gastroenterology & hepatology 27(12):1433–7. https://doi.org/10.1097/meg.0000000000000451

  12. Good NM, Macrae FA, Young GP, O'Dywer J, Slattery M, Venables W et al (2015) Ideal colonoscopic surveillance intervals to reduce incidence of advanced adenoma and colorectal cancer. Journal of gastroenterology and hepatology 30(7):1147–54. https://doi.org/10.1111/jgh.12904

  13. Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T et al (2020) Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 158(4):1131–53.e5. https://doi.org/10.1053/j.gastro.2019.10.026

  14. Rutter MD, East J, Rees CJ, Cripps N, Docherty J, Dolwani S et al (2020) British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 69(2):201–23. https://doi.org/10.1136/gutjnl-2019-319858

  15. Hassan C, Antonelli G, Dumonceau J-M, Regula J, Bretthauer M, Chaussade S et al (2020) Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

  16. Bosman F, Carneiro F, Hruban RE et al (2010) WHO classification of tumors of the digestive system. Lyon: IARC Press

  17. Yi C, Huang Y, Yu X, Li X, Zheng S, Ding K et al (2016) Clinicopathologic distribution of KRAS and BRAF mutations in a Chinese population with colorectal cancer precursor lesions. Oncotarget 7(13):17265–74. https://doi.org/10.18632/oncotarget.7504

  18. Chen H, Lefferts JA, Schwab MC, Suriawinata AA, Tsongalis GJ (2011) Correlation of polypoid colorectal adenocarcinoma with pre-existing adenomatous polyps and KRAS mutation. Cancer genetics 204(5):245–51. https://doi.org/10.1016/j.cancergen.2011.04.002

  19. Ahn JS, Sinn DH, Min YW, Hong SN, Kim HS, Jung SH et al (2017) Non-alcoholic fatty liver diseases and risk of colorectal neoplasia. Alimentary pharmacology & therapeutics 45(2):345–53. https://doi.org/10.1111/apt.13866

  20. Rigter LS, Spaander MCW, Aleman BMP, Bisseling TM, Moons LM, Cats A et al (2019) High prevalence of advanced colorectal neoplasia and serrated polyposis syndrome in Hodgkin lymphoma survivors. Cancer 125(6):990–9. https://doi.org/10.1002/cncr.31903

  21. Belderbos TD, Pullens HJ, Leenders M, Schipper ME, Siersema PD, van Oijen MG (2017) Risk of post-colonoscopy colorectal cancer due to incomplete adenoma resection: a nationwide, population-based cohort study. United European gastroenterology journal 5(3):440–7. https://doi.org/10.1177/2050640616662428

  22. Dai W, Mo S, Xiang W, Han L, Li Q, Wang R et al (2020) The critical role of tumor size in predicting prognosis for T1 colon cancer. The oncologist 25(3):244–51. https://doi.org/10.1634/theoncologist.2019-0469

  23. Betge J, Harbaum L, Pollheimer MJ, Lindtner RA, Kornprat P, Ebert MP et al (2017) Lymph node retrieval in colorectal cancer: determining factors and prognostic significance. International journal of colorectal disease 32(7):991–8. https://doi.org/10.1007/s00384-017-2778-8

  24. Saha S, Shaik M, Johnston G, Saha SK, Berbiglia L, Hicks M et al (2015) Tumor size predicts long-term survival in colon cancer: an analysis of the National Cancer Data Base. American journal of surgery 209(3):570–4. https://doi.org/10.1016/j.amjsurg.2014.12.008

  25. Trepanier M, Erkan A, Kouyoumdjian A, Nassif G, Albert M, Monson J et al (2019) Examining the relationship between lymph node harvest and survival in patients undergoing colectomy for colon adenocarcinoma. Surgery 166(4):639–47. https://doi.org/10.1016/j.surg.2019.03.027

  26. Tsai HL, Huang CW, Yeh YS, Ma CJ, Chen CW, Lu CY et al (2016) Factors affecting number of lymph nodes harvested and the impact of examining a minimum of 12 lymph nodes in stage I-III colorectal cancer patients: a retrospective single institution cohort study of 1167 consecutive patients. BMC surgery 16:17. https://doi.org/10.1186/s12893-016-0132-7

  27. Huang B, Feng Y, Mo SB, Cai SJ, Huang LY (2016) Smaller tumor size is associated with poor survival in T4b colon cancer. World journal of gastroenterology 22(29):6726–35. https://doi.org/10.3748/wjg.v22.i29.6726

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Funding

This work was supported by the national Key R&D Program of China (No. 2017YFC1308800); National Natural Science Foundation of China (No. 81970482); Natural Science Foundation of Guangdong Province, China (No. 2019A1515011313); The Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research- ‘1010’ Program (No. 1010PY(2020)-63), and National Key Clinical Discipline.

Author information

Author notes

  1. Xijie Chen, Jiancong Hu, Liang Xu, and Junguo Chen contributed equally to this manuscript.

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China

    Xijie Chen, Jiancong Hu, Liang Xu, Junguo Chen, Yanyun Lin, Zengjie Chi, Xiaosheng He & Ping Lan

  2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, No 26, Yuancun Erheng Road, Tianhe District, 510655, Guangzhou, Guangdong, China

    Xijie Chen, Jiancong Hu, Liang Xu, Junguo Chen, Yanyun Lin, Zengjie Chi, Xiaosheng He & Ping Lan

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  1. Xijie Chen
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Contributions

XH, XC, and PL conceived and designed the analysis. XC, JH, LX, JC, YL, and ZC collected the data. XC, JH and LX, JC performed the analysis. XC, JH, and LX, JC drafted the original manuscript. All the authors commented on previous versions of the manuscript. XH and PL revised the manuscript and provided professional advice during the whole research process. All the authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xiaosheng He or Ping Lan.

Ethics declarations

Ethics approval

The data contained in the current study were extracted from the open-access SEER database that could be used for medical study. The patient’s name was replaced by an internal ID number that is unable to be accessed by others. The results of the current study will not cause any harm to the patients, and it will be beneficial to subsequent patients. Therefore, no ethical approval is required. This study was conducted adhered to the ethical standards of the World Medical Association Declaration of Helsinki and the Ethical Guidelines for Clinical Research.

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Informed consent was waived in this study.

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This manuscript has not been published in whole or in part nor is it being considered for publication elsewhere. All the authors approved the final version of the article, including the authorship list, and all the authors agree to publish this journal.

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The authors declare no competing interests.

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Chen, X., Hu, J., Xu, L. et al. Nomograms to predict cancer-specific mortality in colon adenocarcinoma with different types of villous architecture. Int J Colorectal Dis 36, 1965–1979 (2021). https://doi.org/10.1007/s00384-021-03997-5

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