Abstract
PurposeTo validate the prognostic value and evaluate the predictive value of response to adjuvant chemotherapy of perineural invasion (PNI) in node-negative colon cancer using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 18 tumor registry database.MethodsPatients diagnosed with colon cancer from the SEER database between January 1, 2010 and December 31, 2015 were identified. Chi-square analysis was performed to evaluate different demographic and clinical features of patients between PNI-negative (PNI (−)) and PNI-positive (PNI (+)) groups. Univariate and multivariate Cox proportional hazard regression models were built to examine the relationship of demographic and clinical features and survival outcomes with the hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsIn total, 57,255 node-negative colon cancer patients were extracted from the SEER database. The receipt of chemotherapy was not an independent prognostic factor for CSS in T3 colon cancer with or without the presence of PNI (P >0.05). The receipt of chemotherapy was independently associated with 34.0% decreased risk of cancer-specific mortality compared with those without the receipt of chemotherapy in T4 colon cancer without the presence of PNI (HR = 0.660, 95%CI = 0.559–0.779, P <0.001); the receipt of chemotherapy was independently associated with 36.0% decreased risk of cancer-specific mortality compared with those without the receipt of chemotherapy in T4 colon cancer with the presence of PNI (HR = 0.640, 95%CI = 0.438–0.935, P = 0.021).ConclusionsThe present study demonstrated the poor prognosis of PNI (+) in both stage I and II colon cancer. However, the presence of PNI was not a predictive factor of response to adjuvant chemotherapy in node-negative colon cancer.
Highlights
As one of the most commonly diagnosed malignant tumors, colon cancer is an important public health issue worldwide [1]
57,255 node-negative colon cancer patients satisfying the inclusion and exclusion criteria were extracted from the SEER database
25,450 (44.5%) patients were diagnosed with stage I disease, 21,090 (26.8%) patients aged less than 65 years old, 28,369 (49.5%) patients were male, 2,372 (4.1%) patients were diagnosed with the presence of perineural invasion (PNI)
Summary
As one of the most commonly diagnosed malignant tumors, colon cancer is an important public health issue worldwide [1]. The TNM staging is not accurate enough to stratify those node-negative (stage I/II) colon cancer patients, and previous studies have indicated the prognostic implications of various histopathological factors [9,10,11,12]. It has been widely reported that the presence of PNI would indicate more aggressive clinicopathological features, resulting in poor prognosis in colorectal cancer, and some previous studies found that PNI could be an indicator for the receipt of chemotherapy in colon cancer [12, 18,19,20,21,22]. The present large population-based study was to validate the prognostic value and evaluate the predictive value of response to adjuvant chemotherapy of PNI in node-negative colon cancer
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