Abstract
Background: Low lymphatic tumor burden is associated with a better prognosis. However, it is uncertain whether those patients diagnosed as cN0 found to be pN+ could be a favorable subgroup in stage III disease. Radical surgery alone might avoid overtreatment in those patients.Methods: Eligible patients diagnosed with colon cancer without metastasis were recruited from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016 using SEER*Stat 8.3.5 software (Surveillance Research Program, National Cancer Institute) and divided into two groups: surgery group (n = 3,081) and surgery followed by adjuvant chemotherapy group (n = 4,591). Overall survival (OS) and cause-specific survival (CSS) differences were assessed by Kaplan–Meier analysis, and survival differences were estimated with log-rank tests. Univariate and multivariate Cox proportional hazard regressions were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for colon cancer patients.Results: A total of 7,672 pT1-3N1a colon cancer patients were recruited from 208,751 colon cancer patients. The 5-year CSS rates of patients without and with adjuvant chemotherapy were 80.0 and 90.7%, respectively. The receipt of adjuvant chemotherapy after the radical resection of the primary tumor was independently associated with 57.3% decreased risk of colon cancer-specific mortality compared with surgery alone (HR = 0.427, 95% CI = 0.370–0.492, P < 0.001, using surgery alone as the reference).Conclusions: Adjuvant chemotherapy was significantly associated with improved prognosis and radical surgery alone did not provide enough treatment for colon cancer with very low lymphatic tumor burden.
Highlights
Low lymphatic tumor burden is associated with a better prognosis
This study aimed to investigate whether radical surgery alone was enough in colon cancer with a very low lymphatic tumor burden, the study subjects were focused on colon cancer with only one lymph node metastasis by postoperative pathologic results, which was not confirmed by preoperative examination
A total of 7,672 pT1-3N1a colon cancer patients who met with the strict inclusion criteria of our analyses, were recruited from 208,751 colon cancer patients included on the SEER database between 2004 and 2016, including 3,714 male (48.4%) and 3,958 female (51.5%) patients
Summary
Low lymphatic tumor burden is associated with a better prognosis It is uncertain whether those patients diagnosed as cN0 found to be pN+ could be a favorable subgroup in stage III disease. A low lymphatic tumor burden could be associated with a better prognosis compared to the higher T stage without lymph node metastasis. It remains uncertain whether those with clinically node-negative colon cancer and pathologically diagnosed node involvement could be a favorable subgroup in stage III disease. This study explores this, examining whether this subgroup of colon cancer patients could be treated with radical surgery alone to avoid overtreatment
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