Abstract
Background: The present study analyzed the nonbiological factors (NBFs) together with the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) staging system to generate a refined, risk-adapted stage for the clinical treatment of colon cancer. Methods: Eligible patients (N = 28,818) with colon cancer between 1 January 2010 and 31 December 2014, were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier curves and Cox proportional hazards regression, analyzed the probabilities of cancer-specific survival (CSS) in patients with colon cancer, with different NBF-TNM stages. Results: Insurance status, marital status, and median household income were significant prognostic NBFs in the current study (p < 0.05). The concordance index of NBF-TNM stage was 0.857 (95% confidence interval (CI) = 0.8472–0.8668). Multivariate Cox analyses, indicated that NBF1-stage was independently associated with a 50.4% increased risk of cancer-specific mortality in colon cancer (p < 0.001), which increased to 77.1% in non-metastatic colon cancer. NBF0-stage improved in CSS as compared to the NBF1-stage in the respective stages (p < 0.05). Conclusions: The new proposed NBF-stage was an independent prognostic factor in colon cancer. Effect of NBFs on the survival of colon cancer necessitates further clinical attention. Moreover, the incorporation of NBF-stage into the AJCC TNM staging system is essential for prognostic prediction, and clinical guidance of adjuvant chemotherapy in stage II and III colon cancer.
Highlights
Colon cancer is one of the most common malignancies and its increasing incidence has been noted over the years in the USA [1]
The results showed that marital status, insurance status, and county-level median household income were significant prognostic nonbiological factors (NBFs) of cancer-specific survival (CSS) in colon cancer
These factors were included in the multivariate Cox hazard regression analysis, and the result showed that NBFs such as insurance status, marital status, and county-level median household income were independently associated with CSS (Table 2)
Summary
Colon cancer is one of the most common malignancies and its increasing incidence has been noted over the years in the USA [1]. The prognostication of AJCC staging system is only based on the invasion extent of the primary tumor (T stage), lymph node status (N stage), and distant spread (M stage) [10]. It is not perfect for prognostic prediction and clinical management, and a better prognostic staging system combined with AJCC staging system and other prognostic factors is needed [10,11,12]. We conducted a large population-based study to analyze the effect of different NBFs, such as employment, education, income, health insurance, year of diagnosis, and marital status on survival in colon cancer cases. We proposed and evaluated a novel NBF-TNM stage (i.e., combination of AJCC staging system and NBF stage), with respect to the prediction of prognosis and clinical management
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