Abstract
BackgroundPathologic staging is crucial in colorectal cancer (CRC). Unlike the majority of solid tumors, the current staging model does not use tumor size as a criterion. We evaluated the predictive and prognostic impact of primary tumor size on all stages of CRC.MethodsUsing the National Cancer Database (NCDB), we conducted an analysis of CRC patients diagnosed between 2010 and 2015 who underwent resection of their primary cancer. Univariate and multivariate analyses were used to identify predictive and prognostic factors, Kaplan-Meier analysis and Cox proportional hazards models for association between tumor size and survival.ResultsAbout 61,000 patients met the inclusion criteria. Median age was 63 years and majority of the tumors were colon primary (82.7%). AJCC stage distribution was: I - 20.1%; II - 32.1%; III - 34.7% and IV - 13.1%. The prognostic impact of tumor size was strongly associated with survival in stage III disease. Compared to patients with tumors <2cm; those with 2-5cm (HR 1.33; 1.19-1.49; p<0.001), 5-10cm (HR 1.51 (1.34-1.70; p<0.001) and >10cm (HR 1.95 (1.65-2.31; p<0.001) had worse survival independent of other variables. Stage II treated without adjuvant chemotherapy had comparable survival outcomes (HR 1.09; 0.97-1.523; p=0.148) with stage III patients who did, while Stage II patients who received adjuvant chemotherapy did much better than both groups (HR 0.76; 0.67-0.86; p<0.001). Stage III patients who did not receive adjuvant chemotherapy had the worst outcomes among the non-metastatic disease subgroups (HR 2.66; 2.48-2.86; p<0.001). Larger tumors were associated with advanced stage, MSI high, non-rectal primary and positive resection margins.ConclusionsFurther studies are needed to clarify the role of tumor size in prognostic staging models, and how to incorporate it into therapy decisions.
Highlights
Colorectal cancer (CRC) affects about 1.8 million people globally, leading to over 600,000 deaths in 2018 alone and is the second leading cause of cancer-related deaths in the United States [1]
Stage II treated without adjuvant chemotherapy had comparable survival outcomes (HR 1.09; 0.97-1.523; p=0.148) with stage III patients who did, while Stage II patients who received adjuvant chemotherapy did much better than both groups (HR 0.76; 0.67-0.86; p
Further studies are needed to clarify the role of tumor size in prognostic staging models, and how to incorporate it into therapy decisions
Summary
Colorectal cancer (CRC) affects about 1.8 million people globally, leading to over 600,000 deaths in 2018 alone and is the second leading cause of cancer-related deaths in the United States [1]. The 5-year relative survival for patients diagnosed with colorectal cancer is 66% [3]. This varied from 90.6% for localized disease to 14.7% for patients with distant spread. The prognostic significance of the tumor size/ horizontal growth of most solid tumors in the TNM staging is reflected by its major role in determining the prognosis, recurrence, survival, and clinical management [6]. Colorectal cancer spreads horizontally and invade through the depth of the various layers of the colon wall. The current AJCC colorectal cancer T stage uses depth of tumor invasion rather than tumor size/ horizontal spread. We evaluated the predictive and prognostic impact of primary tumor size on all stages of CRC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
