Multiple High-Risk Features for Stage II Colon Carcinoma Portends Worse Survival Than Stage III Disease
Diseases of the Colon and Rectum
BACKGROUND: High-risk features in stage II colon cancer worsen survival and serve as an impetus for adjuvant chemotherapy. Limited data exist on the effect of multiple high-risk features on survival. OBJECTIVE: The study aimed to compare the survival of 0, 1, or multiple high-risk features in stage II to stage III colon cancer. DESIGN: Patients with stage II and III colon cancer diagnosed between 2010 and 2016 were identified using the Survival, Epidemiology, and End Results database. Patients with stage II colon cancer were then classified according to the presence of 0, 1, or 2 or more of the following high-risk features: pathologic T4, perineural invasion, fewer than 12 lymph nodes assessed, or poor histologic differentiation. Overall survival and cause-specific survival were calculated. Each group was then stratified on the basis of whether chemotherapy was given. SETTINGS: This study used the Survival, Epidemiology, and End Results database (2010-2016). PATIENTS: Patients who had stage II or III colon cancer were included. MAIN OUTCOME MEASURES: The primary outcome measures were 5-year overall survival and cause-specific survival. RESULTS: A total of 65,831 patients were studied. Of these, 18,056 patients with stage II cancer had 0 high-risk features, 9426 had 1 high-risk feature, and 3503 had 2 or more high-risk features. There were 34,842 patients diagnosed with stage III disease. The 5-year overall survival and cause-specific survival for patients with stage II cancer with 2 or more high-risk features (49.2%, 59.5%) were lower than those without high-risk features (74.9%, 90.7%), with 1 high-risk feature (67.1%, 82.4%), or stage III disease (59.1%, 68.1%; p < 0.05). Although chemotherapy is associated with improved cause-specific survival in stage III disease, it is associated with worse cause-specific survival in patients with stage II disease. LIMITATIONS: This study being a retrospective database analysis is the main limitation. Also, lymphovascular invasion, margin status, and clinical obstruction or perforation were absent from the dataset. CONCLUSIONS: Multiple high-risk features in stage II colon cancer predict worse survival than lymph node metastasis. Chemotherapy is associated with adverse cause-specific survival in patients with stage II disease. Further study into this group should focus on the type and duration of adjuvant therapy and biological features of these tumors.
Hajirawala, Luv N.; Yi, Yong; Herritt, Brian C.; Laurent, Morgan E.; Klinger, Aaron L.; Orangio, Guy R.; Davis, Kurt G.; and Barton, Jeffrey S., "Multiple High-Risk Features for Stage II Colon Carcinoma Portends Worse Survival Than Stage III Disease" (2022). School of Medicine Faculty Publications. 1447.