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Unfavorable effect of small tumor size on cause-specific survival in stage IIA colon cancer, a SEER-based study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

We sought to determine the prognostic role of tumor size on cause-specific survival (CSS) of patients with stage IIA colon cancer.

Methods

Surveillance, Epidemiology and End Results (SEER) database was utilized to identify patients with stage IIA colorectal cancer (examined lymph nodes ≥12) diagnosed from 1988 to 2003. The prognostic effect of tumor size on CSS was evaluated by univariate and multivariate analyses.

Results

A total of 8775 patients were enrolled in the analysis. The median follow-up time was 109 months. As determined by minimal P value method, tumor sizes of 2.5 and 6.0 cm were used as optimal cutoff value to divide the cohort. The 8-year CSS of colon cancer with tumor sizes ≤2.5, 2.6–6.0, and >6.0 cm was 81.6, 86.2, and 86.7 % respectively (P = 0.003). In the multivariate analysis of colon cancer, using ≤2.5-cm tumors as reference, decreased hazard ratio (HR) of CSS was observed in 2.6–6.0 cm (HR, 0.736; 95 % confidence interval (CI), 0.599–0.905; P = 0.004) and >6.0 cm (HR, 0.770; 95 % CI, 0.619–0.958; P = 0.019) tumors.

Conclusions

In stage IIA colon cancer, small tumor size represented a subset with decreased CSS. Further studies are merited to validate the unfavorable prognostic role of small tumor size in stage IIA colon cancer.

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References

  1. O'Connor ES, Greenblatt DY, LoConte NK et al (2011) Adjuvant chemotherapy for stage ii colon cancer with poor prognostic features. J Clin Oncol 29(25):3381–3388

    Article  PubMed Central  PubMed  Google Scholar 

  2. Gill S, Loprinzi CL, Sargent DJ et al (2004) Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 22(10):1797–1806

    Article  CAS  PubMed  Google Scholar 

  3. Figueredo A, Charette ML, Maroun J et al (2004) Adjuvant therapy for stage ii colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care's gastrointestinal cancer disease site group. J Clin Oncol 22(16):3395–3407

    Article  PubMed  Google Scholar 

  4. Benson AR, Schrag D, Somerfield MR et al (2004) American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22(16):3408–3419

    Article  PubMed  Google Scholar 

  5. Benson AR, Hamilton SR (2011) Path toward prognostication and prediction: an evolving matrix. J Clin Oncol 29(35):4599–4601

    Article  PubMed  Google Scholar 

  6. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474

    Article  PubMed  Google Scholar 

  7. Al NR, Saund MS, Sanchez VM et al (2012) Tumor size and depth predict rate of lymph node metastasis in colon carcinoids and can be used to select patients for endoscopic resection. J Gastrointest Surg 16(3):595–602

    Article  Google Scholar 

  8. Saund MS, Al NR, Sharma AM et al (2011) Tumor size and depth predict rate of lymph node metastasis and utilization of lymph node sampling in surgically managed gastric carcinoids. Ann Surg Oncol 18(10):2826–2832

    Article  PubMed  Google Scholar 

  9. Adachi Y, Oshiro T, Mori M et al (1997) Tumor size as a simple prognostic indicator for gastric carcinoma. Ann Surg Oncol 4(2):137–140

    Article  CAS  PubMed  Google Scholar 

  10. Liu X, Xu Y, Long Z et al (2009) Prognostic significance of tumor size in T3 gastric cancer. Ann Surg Oncol 16(7):1875–1882

    Article  PubMed  Google Scholar 

  11. Wang HM, Huang CM, Zheng CH et al (2012) Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach. World J Gastroenterol 18(38):5470–5475

    Article  PubMed Central  PubMed  Google Scholar 

  12. Quan J, Zhang R, Liang H et al (2013) The impact of tumor size on survival of patients with pT4aN0M0 gastric cancer. Am Surg 79(3):328–331

    PubMed  Google Scholar 

  13. Crozier JE, McMillan DC, McArdle CS et al (2007) Tumor size is associated with the systemic inflammatory response but not survival in patients with primary operable colorectal cancer. J Gastroenterol Hepatol 22(12):2288–2291

    Article  PubMed  Google Scholar 

  14. Kanemitsu Y, Kato T, Hirai T et al (2003) Survival after curative resection for mucinous adenocarcinoma of the colorectum. Dis Colon Rectum 46(2):160–167

    Article  PubMed  Google Scholar 

  15. Wang WS, Lin JK, Chiou TJ et al (2000) Preoperative carcinoembryonic antigen level as an independent prognostic factor in colorectal cancer: Taiwan experience. Jpn J Clin Oncol 30(1):12–16

    Article  PubMed  Google Scholar 

  16. Park YJ, Park KJ, Park JG et al (1999) Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg 23(7):721–726

    Article  CAS  PubMed  Google Scholar 

  17. Ropponen K, Eskelinen M, Kosma VM et al (1996) Comparison of classic and quantitative prognostic factors in colorectal cancer. Anticancer Res 16(6B):3875–3882

    CAS  PubMed  Google Scholar 

  18. D'Eredita G, Serio G, Neri V et al (1996) A survival regression analysis of prognostic factors in colorectal cancer. Aust N Z J Surg 66(7):445–451

    Article  PubMed  Google Scholar 

  19. Griffin MR, Bergstralh EJ, Coffey RJ et al (1987) Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 60(9):2318–2324

    Article  CAS  PubMed  Google Scholar 

  20. Miller W, Ota D, Giacco G et al (1985) Absence of a relationship of size of primary colon carcinoma with metastasis and survival. Clin Exp Metastasis 3(3):189–196

    Article  CAS  PubMed  Google Scholar 

  21. Steinberg SM, Barwick KW, Stablein DM (1986) Importance of tumor pathology and morphology in patients with surgically resected colon cancer. Findings from the gastrointestinal tumor study group. Cancer 58(6):1340–1345

    Article  CAS  PubMed  Google Scholar 

  22. Bjerkeset T, Morild I, Mork S et al (1987) Tumor characteristics in colorectal cancer and their relationship to treatment and prognosis. Dis Colon Rectum 30(12):934–938

    Article  CAS  PubMed  Google Scholar 

  23. Wiggers T, Arends JW, Schutte B et al (1988) A multivariate analysis of pathologic prognostic indicators in large bowel cancer. Cancer 61(2):386–395

    Article  CAS  PubMed  Google Scholar 

  24. Stahle E, Glimelius B, Bergstrom R et al (1988) Preoperative clinical and pathological variables in prognostic evaluation of patients with rectal cancer. A prospective study of 327 consecutive patients. Acta Chir Scand 154(3):231–239

    CAS  PubMed  Google Scholar 

  25. Minsky BD, Mies C, Rich TA et al (1988) Potentially curative surgery of colon cancer: patterns of failure and survival. J Clin Oncol 6(1):106–118

    CAS  PubMed  Google Scholar 

  26. Moghimi-Dehkordi B, Safaee A, Zali MR (2008) Prognostic factors in 1,138 Iranian colorectal cancer patients. Int J Colorectal Dis 23(7):683–688

    Article  PubMed  Google Scholar 

  27. Zhai ZW, Gu J (2012) Influence of tumor size on the prognosis in patients with colon cancer. Zhonghua Wei Chang Wai Ke Za Zhi 15(5):495–498

    PubMed  Google Scholar 

  28. Kornprat P, Pollheimer MJ, Lindtner RA et al (2011) Value of tumor size as a prognostic variable in colorectal cancer: a critical reappraisal. Am J Clin Oncol 34(1):43–49

    Article  PubMed  Google Scholar 

  29. Bonelli L, Martines H, Conio M et al (1988) Family history of colorectal cancer as a risk factor for benign and malignant tumours of the large bowel. A case–control study. Int J Cancer 41(4):513–517

    Article  CAS  PubMed  Google Scholar 

  30. Hampel H, Frankel WL, Martin E et al (2008) Feasibility of screening for lynch syndrome among patients with colorectal cancer. J Clin Oncol 26(35):5783–5788

    Article  PubMed Central  PubMed  Google Scholar 

  31. Gunderson LL, Jessup JM, Sargent DJ et al (2010) Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol 28(2):256–263

    Article  PubMed Central  PubMed  Google Scholar 

  32. Camp RL, Dolled-Filhart M, Rimm DL (2004) X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res 10(21):7252–7259

    Article  CAS  PubMed  Google Scholar 

  33. Li F, Kishida T, Kobayashi M (1999) Serum iron and ferritin levels in patients with colorectal cancer in relation to the size, site, and disease stage of cancer. J Gastroenterol 34(2):195–199

    Article  CAS  PubMed  Google Scholar 

  34. Adachi Y, Yasuda K, Kakisako K et al (1999) Histopathologic criteria for local excision of colorectal cancer: multivariate analysis. Ann Surg Oncol 6(4):385–388

    Article  CAS  PubMed  Google Scholar 

  35. Hotta T, Takifuji K, Yokoyama S et al (2006) Survival in colorectal cancer patients with urinary tract invasion. Dis Colon Rectum 49(9):1399–1409

    Article  PubMed  Google Scholar 

  36. Wolmark N, Fisher ER, Wieand HS et al (1984) The relationship of depth of penetration and tumor size to the number of positive nodes in Dukes C colorectal cancer. Cancer 53(12):2707–2712

    Article  CAS  PubMed  Google Scholar 

  37. Mulcahy HE, Toner M, Patchett SE et al (1997) Identifying stage B colorectal cancer patients at high risk of tumor recurrence and death. Dis Colon Rectum 40(3):326–331

    Article  CAS  PubMed  Google Scholar 

  38. Takahashi T, Kato T, Kodaira S et al (1996) Prognostic factors of colorectal cancer. Results of multivariate analysis of curative resection cases with or without adjuvant chemotherapy. Am J Clin Oncol 19(4):408–415

    Article  CAS  PubMed  Google Scholar 

  39. Schmidt-Kittler O, Ragg T, Daskalakis A et al (2003) From latent disseminated cells to overt metastasis: genetic analysis of systemic breast cancer progression. Proc Natl Acad Sci U S A 100(13):7737–7742

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Kye BH, Jung JH, Kim HJ et al (2012) Tumor budding as a risk factor of lymph node metastasis in submucosal invasive T1 colorectal carcinoma: a retrospective study. BMC Surg 12:16

    Article  PubMed Central  PubMed  Google Scholar 

  41. Sugimoto K, Kawai M, Takehara K et al (2013) T1 colorectal cancer with synchronous liver metastasis. Case Rep Gastroenterol 7(2):266–271

    Article  PubMed Central  PubMed  Google Scholar 

  42. Ren B, Zakharov V, Yang Q et al (2013) MACC1 is related to colorectal cancer initiation and early-stage invasive growth. Am J Clin Pathol 140(5):701–707

    Article  PubMed  Google Scholar 

  43. Ueno H, Hase K, Hashiguchi Y et al. (2013) Novel risk factors for lymph node metastasis in early invasive colorectal cancer: a multi-institution pathology review [J]. J Gastroenterol

  44. Mou S, Soetikno R, Shimoda T et al (2013) Pathologic predictive factors for lymph node metastasis in submucosal invasive (T1) colorectal cancer: a systematic review and meta-analysis. Surg Endosc 27(8):2692–2703

    Article  PubMed  Google Scholar 

  45. Wo JY, Chen K, Neville BA et al (2011) Effect of very small tumor size on cancer-specific mortality in node-positive breast cancer. J Clin Oncol 29(19):2619–2627

    Article  PubMed Central  PubMed  Google Scholar 

  46. Yu KD, Jiang YZ, Chen S et al (2012) Effect of large tumor size on cancer-specific mortality in node-negative breast cancer. Mayo Clin Proc 87(12):1171–1180

    Article  PubMed Central  PubMed  Google Scholar 

  47. Chaffer CL, Weinberg RA (2011) A perspective on cancer cell metastasis. Science 331(6024):1559–1564

    Article  CAS  PubMed  Google Scholar 

  48. Wright FC, Law CH, Last L et al (2003) Lymph node retrieval and assessment in stage ii colorectal cancer: a population-based study. Ann Surg Oncol 10(8):903–909

    Article  CAS  PubMed  Google Scholar 

  49. Chou JF, Row D, Gonen M et al (2010) Clinical and pathologic factors that predict lymph node yield from surgical specimens in colorectal cancer: a population-based study. Cancer 116(11):2560–2570

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the grant of the National Natural Science Foundation of China (No.81001055), Shanghai Pujiang Program (No.13PJD008). The authors would like to thank SEER program for public access of the database.

Authors’ contributions

Xu Ye, Cai Guoxiang, and Cai Sanjun are responsible for the study conception and design. Wang Yuwei, Changhua Zhuo and Gu Weilie acquired the data. Wang Yuwei, Shi Debing, and Zheng Hongtu analyzed and interpreted the data. Wang Yuwei and Shi Debing wrote the manuscript.

Conflict of interest

No conflict of interest.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China

    Yuwei Wang, Changhua Zhuo, Debing Shi, Hongtu Zheng, Ye Xu, Weilie Gu, Sanjun Cai & Guoxiang Cai

  2. Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Road, Shanghai, 200032, China

    Yuwei Wang, Changhua Zhuo, Debing Shi, Hongtu Zheng, Ye Xu, Weilie Gu, Sanjun Cai & Guoxiang Cai

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  1. Yuwei Wang
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  2. Changhua Zhuo
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  5. Ye Xu
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Corresponding authors

Correspondence to Sanjun Cai or Guoxiang Cai.

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Statement

A population-based study was conducted utilizing the SEER database to evaluate the prognostic significance of tumor size among stage IIA colon cancer. Surprisingly, very small tumor size may predict for worse cause-specific overall survival.

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Wang, Y., Zhuo, C., Shi, D. et al. Unfavorable effect of small tumor size on cause-specific survival in stage IIA colon cancer, a SEER-based study. Int J Colorectal Dis 30, 131–137 (2015). https://doi.org/10.1007/s00384-014-2056-y

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  • DOI: https://doi.org/10.1007/s00384-014-2056-y

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