Increased cancer-specific mortality of very small size in carcinoembryonic antigen-elevated rectal cancer

Abstract

Background: The present study aimed to investigate the cause-specific survival (CSS) of very small rectal cancer in the context of preoperative serum carcinoembryonic antigen (CEA) elevation.Methods: Patients diagnosed with node-negative rectal cancer from the Surveillance, Epidemiology, and End Results (SEER) database from January 2004 to December 2010 meeting the inclusion criteria were identified for this study. The Cox proportional hazards regression analyses were conducted to identify independent factors associated with CSS. Pearson's chi-squared tests and Kaplan-Meier methods were performed.Results: A total of 8,413 patients were included into our study. Kaplan-Meier analyses showed lower 7-year CSS rate of very small tumors (≤5 mm) compared to those larger than 40 mm (70.4% vs. 76.0%, logrank P=0.469). Multivariate Cox analyses showed that patients with very small tumor size (≤5 mm) was also associated with a significantly increased risk of cancer-specific mortality compared with those with large tumor size (HR =2.567, 95% CI: 1.285 to 5.130, P=0.008, using ≥41 mm, C+ as a reference).Conclusions: Very small tumor size in the context of preoperative serum CEA elevation could be a surrogate for biological aggressiveness. Our finding would provide a better understanding of tumor biology for us and elicit more future biological researches.

Tumor Deposits and Perineural Invasion had Comparable Impacts on the Survival of Patients With Non-metastatic Colorectal Adenocarcinoma: A Population-Based Propensity Score Matching and Competing Risk Analysis

“…Several studies suggested that small size tumor had worse survival compared with large size tumor, if the TNM stage of CRC patients were similar. 19 - 23 …”

“…Several studies suggested that small size tumor had worse survival compared with large size tumor, if the TNM stage of CRC patients were similar. [19][20][21][22][23] Our study also quantitatively analyzed risk factors related to TD and PNI status through bivariate logistic regression analysis. For TD, the most important risk factor was N stage.…”

Prognostic Value of Tumor Size in Colon Cancer—Smaller is Better?

“…5,6 Interestingly, several studies have also shown that patients with a smaller tumor size in pancreatic cancer, 7 breast cancer, 8 and certain T stage colon cancer [9][10][11][12][13][14][15][16] have a poorer prognosis, which is contrary to common knowledge; further, several studies have revealed an early spreading phenomenon of cancer cells. 15,[17][18][19][20] Most previous studies on tumor size were based on data extracted from open databases, 6,[9][10][11]13,15,16,21 which cannot be analyzed in depth owing to loss of information for several essential high-risk factors, such as lymphovascular invasion (LVI), perineural invasion (PNI), tumor deposit, BRAF or KRAS mutation, positive circumferential resection margin (CRM), and MMR status. The correlation between tumor size and these pathological features is still unclear.…”

“…Most previous studies on tumor size were based on data extracted from open databases, 6,9-11,13,15,16,21 which cannot be analyzed in depth owing to loss of information for several essential high-risk factors, such as lymphovascular invasion (LVI), perineural invasion (PNI), tumor deposit, BRAF or KRAS mutation, positive circumferential resection margin (CRM), and MMR status. The correlation between tumor size and these pathological features is still unclear.…”