Current treatment and surveillance modalities are not sufficient for advanced stage III colon cancer: Result from a multicenter cohort analysis

Juan Li; Yumo Xie; Ziying Huang; Dingcheng Shen; Zhuokai Zhuang; Mingxuan Zhu; Yaoyi Huang; Rongzhao He; Xiaolin Wang; Meijin Huang; Yanxin Luo; Huichuan Yu

doi:10.1002/cam4.4417

Current treatment and surveillance modalities are not sufficient for advanced stage III colon cancer: Result from a multicenter cohort analysis

Cancer Med. 2021 Dec;10(24):8924-8933. doi: 10.1002/cam4.4417. Epub 2021 Nov 16.

Authors

Juan Li¹, Yumo Xie^{1

2}, Ziying Huang³, Dingcheng Shen^{1

2}, Zhuokai Zhuang^{1

2}, Mingxuan Zhu^{1

2}, Yaoyi Huang^{1

2}, Rongzhao He^{1

2}, Xiaolin Wang^{1

2}, Meijin Huang^{1

2}, Yanxin Luo^{1

2}, Huichuan Yu^{1

2}

Affiliations

¹ Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
² Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China.

Abstract

Objective: We conducted this multicenter cohort study to evaluate the current tumor-node-metastasis staging system and treatment modality by analyzing the survival outcomes of patient groups with stage III and IV colon cancer.

Patients and methods: Stage III and IV colon cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database (SEER cohort) and prospectively maintained Sun Yat-sen University (SYSU) cohort were included in this study. Kaplan-Meier method was used to estimate the cumulative rate of overall survival (OS) between patient groups, and the inverse probability weighting method was used to calculated age and sex-adjusted survival curves. The Cox regression model was used to identify the risk factors for OS.

Results: A total of 17,911 and 1135 stage III-IV cases were included in the SEER and SYSU cohorts, respectively. Among them, 1448 and 124 resectable stage IV cases underwent curative-intent treatment in the SEER and SYSU cohorts, respectively. The T4N2b group showed a significantly worse survival outcome compared with the M1a subset receiving curative-intent treatment (HR, 1.46; p < 0.001). This finding was validated in the SYSU cohort, in which the T4N2 group had a worse outcome than that of the M1 group receiving curative-intent treatment (HR, 2.44; p < 0.001). These findings were confirmed in the adjusted survival analysis. In the multivariate analysis, the right-side tumor, poor-undifferentiated tumor, and age over 60 years were identified as independent risk factors for T4N2b patients. Based on this multivariate model, the high-risk T4N2b subgroup had a worse survival outcome compared with resectable M1b patients (HR, 1.24; p = 0.03).

Conclusion: By comparing stage III with stage IV colon cancer patients, we identified a subgroup of stage III patients at a higher risk of death than more advanced stages, implying that current cancer care modalities are not sufficient for these high-risk substages.

Keywords: SEER; advanced stage; colorectal cancer; management; survival; treatment; tumor staging.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chronic Disease Indicators
Cohort Studies
Colonic Neoplasms / mortality
Colonic Neoplasms / therapy*
Female
Humans
Male
Middle Aged
Neoplasm Staging
Prognosis
Survival Analysis