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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Conflict of interest

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

Author information

Authors and Affiliations

  1. Center for Colorectal Cancer, National Cancer Center, Goyang, Korea

    Min Jung Kim MD, Jae Hwan Oh MD, PhD & Jae-Gahb Park MD, PhD

  2. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Seung-Yong Jeong MD, PhD, Sang-ji Choi MD, Seung-Bum Ryoo MD, Ji Won Park MD, Kyu Joo Park MD, PhD, Sung-Bum Kang MD, PhD & Seung Chul Heo MD, PhD

  3. Cancer Research Institute, Seoul National University, Seoul, Korea

    Seung-Yong Jeong MD, PhD, Ji Won Park MD & Jae-Gahb Park MD, PhD

  4. Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea

    Seung-Yong Jeong MD, PhD, Ji Won Park MD & Kyu Joo Park MD, PhD

  5. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

    Sung-Bum Kang MD, PhD

  6. Department of Surgery, Hallym University College of Medicine, Anyang, Korea

    Hyoung-Chul Park MD, PhD

  7. Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea

    Seung Chul Heo MD, PhD

Authors
  1. Min Jung Kim MD
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  2. Seung-Yong Jeong MD, PhD
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  3. Sang-ji Choi MD
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  4. Seung-Bum Ryoo MD
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  6. Kyu Joo Park MD, PhD
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  7. Jae Hwan Oh MD, PhD
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  8. Sung-Bum Kang MD, PhD
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  9. Hyoung-Chul Park MD, PhD
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  10. Seung Chul Heo MD, PhD
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  11. Jae-Gahb Park MD, PhD
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Corresponding author

Correspondence to Seung-Yong Jeong MD, PhD.

Additional information

On behalf of the Seoul colorectal group (SECOG).

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Kim, M.J., Jeong, SY., Choi, Sj. et al. Survival Paradox Between Stage IIB/C (T4N0) and Stage IIIA (T1-2N1) Colon Cancer. Ann Surg Oncol 22, 505–512 (2015). https://doi.org/10.1245/s10434-014-3982-1

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  • DOI: https://doi.org/10.1245/s10434-014-3982-1

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