Abstract
ObjectiveWe conducted this large population-based study to re-evaluate the survival paradox between stage IIB/C and stage IIIA colon cancer based on the newest staging criteria.MethodsColon cancer patients were recruited from the Surveillance, Epidemiology, and End Results (SEER) database using SEER*Stat software (version 8.3.4) with strict inclusion criteria. We used Chi-square test to compare categorical variables between patients diagnosed with stage IIB/IIC and stage IIIA colon cancer. Survival probabilities were then assessed using the Kaplan–Meier method. Cox proportional hazards models were used to analyze hazard ratios (HRs) and 95% confidence intervals (CIs) of clinicopathologic characteristics in stage IIB/IIC and stage IIIA colon cancer patients.ResultsIn the current study, a total of 9,227 eligible colon cancer patients were collected from the SEER database between 2010 and 2015. It was found that stage IIIA had 66.4% decreased risk of colon cancer-specific mortality compared with stage IIB (HR = 0.336, 95%CI = 0.286–0.394 for stage IIIA, P < 0.001, using stage IIB as the reference) after the adjustment for other known prognostic factors. And T1N2a colon cancer had significantly lower 5-year overall survival (OS) rate compared with T2N1 disease (74.7% vs. 57.1%, P = 0.018).ConclusionsOur study confirmed the existence of survival paradox between stage IIB/IIC and stage IIIA colon cancer based on the newest staging criteria. What is more, the subgroup analyses revealed that T1N2a had the least influence on the survival paradox. N2a colon cancer seemed to be associated with worse prognosis than T2 disease, which would give us a better understanding of tumor biology of colon cancer and be conducive to the refinement of individualized treatment regimens in stage III disease.
Highlights
Colon cancer was one of the most common malignant tumors worldwide [1]
Of the 9,227 patients diagnosed with stage IIB/IIC and stage IIIA colon cancer, 4,459 (48.3%) patients were female and 4,768 (51.7%) patients were male
Based on the chi-squared test between stage IIB/IIC and stage IIIA colon cancer, stage IIIA was found to be associated with younger age (P < 0.001), black race (P < 0.001), male (P = 0.016), grade I/II (P < 0.001), adenocarcinoma (P < 0.001), low number of lymph nodes retrieved (P < 0.001), and the receipt of chemotherapy (P < 0.001), indicating that stage IIIA patients were more likely to be associated with some favorable clinicopathological characteristics (Table 1)
Summary
The American Joint Committee on Cancer (AJCC) TNM staging system was the most commonly used reference index for the guidance of treatment and the judgment of prognosis in many solid cancers. The AJCC staging system could accurately predict the prognosis of cancer patients, with lower stage cancers having better prognosis than higher stage cancers in most solid cancers [2]. A survival paradox could be observed between stage IIB/C (T4N0) and stage IIIA (T1-2N1, T1N2a) tumors in previous studies [3,4,5,6,7]. No large population-based studies had been reported to evaluate the prognosis of subgroups in stage IIB/C and stage IIIA colon cancer behind the survival paradox according to the newest AJCC TNM staging criteria
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