Annals of Surgical Oncology

, Volume 22, Issue 2, pp 505–512 | Cite as

Survival Paradox Between Stage IIB/C (T4N0) and Stage IIIA (T1-2N1) Colon Cancer

  • Min Jung Kim
  • Seung-Yong JeongEmail author
  • Sang-ji Choi
  • Seung-Bum Ryoo
  • Ji Won Park
  • Kyu Joo Park
  • Jae Hwan Oh
  • Sung-Bum Kang
  • Hyoung-Chul Park
  • Seung Chul Heo
  • Jae-Gahb Park
Colorectal Cancer



The survival paradox between stage IIB/C (T4N0) and stage IIIA (T1-2N1) colon cancer remains in the 7th edition of the American Joint Committee on Cancer staging system. This multicenter study aimed to compare the oncologic outcomes of T4N0 and T1-2N1 colon cancers and to investigate the presumptive prognostic factors that might influence the survival paradox.


Patients who underwent curative surgery for pT4N0 (n = 224) and pT1-2N1 (n = 135) primary colon cancer between January 1999 and December 2010 at five tertiary referral cancer centers were included for analysis. The clinicopathologic, treatment-related factors, and oncologic outcomes in terms of the 5-year overall survival (5-OS) and 5-year disease-free survival (5-DFS) were compared.


The T4N0 group had significantly worse 5-OS and 5-DFS rates than the T1-2N1 group (5-OS: 84.0 vs. 92.3 %, p = 0.012; 5-DFS: 73.6 vs. 88.0 %, p = 0.001). T4N0 cancers more frequently showed elevated preoperative carcinoembryonic antigen, lower grade of differentiation, larger tumor size, and higher proportions of perineural invasion, microsatellite instability, obstruction, and perforation than T1-2N1 cancers. Peritoneal seeding and liver metastasis were the predominant recurrence pattern in the T4N0 and T1-2N1 groups, respectively (p = 0.042). The T4N0 group showed inferior survival to the T1-2N1 group in postoperative adjuvant chemotherapy (5-OS: 87.1 vs. 93.2 %, p = 0.045; 5-DFS: 76.1 vs. 89.0 %, p = 0.001).


T4N0 colon cancer had significantly worse oncologic outcomes than T1-2N1 cancer regardless of adjuvant chemotherapy. The survival paradox may result from the biologic aggressiveness of T4N0 colon carcinomas.


Adjuvant Chemotherapy Oncologic Outcome T4N0 Tumor Colon Carcinoma Patient Tertiary Referral Cancer Center 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors declare there are no conflicts of interest or financial ties to disclose.

Supplementary material

10434_2014_3982_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)
10434_2014_3982_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 13 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Min Jung Kim
    • 1
  • Seung-Yong Jeong
    • 2
    • 3
    • 4
    Email author
  • Sang-ji Choi
    • 2
  • Seung-Bum Ryoo
    • 2
  • Ji Won Park
    • 2
    • 3
    • 4
  • Kyu Joo Park
    • 2
    • 4
  • Jae Hwan Oh
    • 1
  • Sung-Bum Kang
    • 2
    • 5
  • Hyoung-Chul Park
    • 6
  • Seung Chul Heo
    • 2
    • 7
  • Jae-Gahb Park
    • 1
    • 3
  1. 1.Center for Colorectal CancerNational Cancer CenterGoyangKorea
  2. 2.Department of SurgerySeoul National University College of MedicineSeoulKorea
  3. 3.Cancer Research InstituteSeoul National UniversitySeoulKorea
  4. 4.Colorectal Cancer CenterSeoul National University Cancer HospitalSeoulKorea
  5. 5.Department of SurgerySeoul National University Bundang HospitalSeongnamKorea
  6. 6.Department of SurgeryHallym University College of MedicineAnyangKorea
  7. 7.Department of SurgerySeoul Metropolitan Government-Seoul National University Boramae Medical CenterSeoulKorea

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