New findings in prognostic factor assessment for adenocarcinoma of transverse colon: a comparison study between competing-risk and COX regression analysis

Hongbo Su; Shuping Xie; Shanshan Wang; Liying Huang; Jun Lyu; Yunlong Pan

doi:10.3389/fmed.2024.1301487

New findings in prognostic factor assessment for adenocarcinoma of transverse colon: a comparison study between competing-risk and COX regression analysis

Front Med (Lausanne). 2024 Jan 31:11:1301487. doi: 10.3389/fmed.2024.1301487. eCollection 2024.

Authors

Hongbo Su^#¹, Shuping Xie^#², Shanshan Wang³, Liying Huang⁴, Jun Lyu^{4

5}, Yunlong Pan¹

Affiliations

¹ Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
² Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.
³ Section of Occupational Medicine, Department of Special Medicine, Shanxi Medical University, Taiyuan, Shanxi, China.
⁴ Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
⁵ Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China.

^# Contributed equally.

Abstract

Purpose: Competing-risk analysis was used to accurately assess prognostic factors for cancer-specific death in patients with adenocarcinoma of transverse colon (ATC), and the results were compared with those from a conventional Cox regression analysis.

Materials and methods: Patients diagnosed with ATC between 2000 and 2019 were selected from the Surveillance, Epidemiology, and End Results database. The crude mortality rates of patients with ATC were calculated and their differences were tested using the Gray's test, respectively. In performing multivariate analysis, the Cox regression model and the subdistribution hazard function (SD) in competing risk analysis were utilized, respectively.

Results: This study included 21,477 eligible patients. The SD model indicated that age, etc. are actual independent prognostic factors. In contrast to previous recognition, the results of the Cox regression showed false-positives for sex and Carcinoembryonic antigen, and underestimated point-estimates in the stage and American Joint Committee on Cancer stage due to competing events. A detailed comparison of treatment revealed that the larger surgical scopes were prognostic risk factors compared with the smaller scope of local tumor excision, partial colectomy, or segmental resection. Patients treated with external proton beam radiotherapy had an increased risk compared with those with no radiotherapy and internal radiotherapy.

Conclusions: After comparing the results of the two methods and mitigating the significant bias introduced by Cox regression, we found independent factors that really affect the prognosis of ATC. On the other hand, in terms of ATC, a larger surgical scope and external proton beam radiotherapy may not improve the long-term survival of patients. Therefore, when faced with ATC patients, these differences should be noted and treated differently from common colorectal cancer patients. Thus, clinicians are able to give more targeted treatment plans and prognostic assessments.

Keywords: Cox regression; SEER; adenocarcinoma of transverse colon; competing-risk analysis; subdistribution hazard function.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Guangzhou Science and Technology Plan City-School Joint Funding Project (202201020084 and 202201020065), the Clinical Frontier Technology Program of the First Affiliated Hospital of Jinan University, China (No. JNU1AF-CFTP-2022a01223), and the Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization (2021B1212040007).