Survival Paradox Between Stage IIB/C (T4N0) and Stage IIIA (T1-2N1) Colon Cancer

Kim, Min Jung; Jeong, Seung‐Yong; Choi, Sang ji; Ryoo, Seung Bum; Park, Ji Won; Park, Kyu Joo; Oh, Jae Hwan; Kang, Sung Bum; Park, Hyoung Chul; Heo, Sung Hyuk; Park, Jae Gahb

doi:10.1245/s10434-014-3982-1

Cited by 87 publications

(79 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… a Cox proportional hazards models adjusted for stage (IIB/IIC [reference], IIIA), age ( ≤ 65 [reference], > 65), BMI ( < 25 [reference], ≥ 25), ASA (1,2 [reference], ), preoperative CEA ( ≤ 5 [reference], > ), Tumor location (right [reference], left), obstruction or perforation (no [reference], yes), Adjuvant Chemotherapy (no [reference], yes), examined lymph node ( < 12 [reference], ≥ ), tumor size ( < 5 [reference], ≥ ), histology (well, moderate [reference], poor, mucinous), LVI or PNI (no [reference], yes), radial margin status (negative [reference], positive).…”

Section: Resultsmentioning

confidence: 99%

“…Several explanations have been proposed for the inferior survival in stage IIB/IIC compared with that in stage IIIA, including improper en‐bloc resection, especially in cases of stage IIC; lower use of systemic chemotherapy in patients at stage IIB/IIC; stage migration due to inadequate node dissection; and aggressive biological characteristics . However, only a few studies have directly compared the survival rates of the two groups after adjusting for these proposed confounding factors . Moreover, these previous studies may be limited by long study periods of more than 10 years, which may not reflect the effects of modern treatment modalities in terms of surgical techniques and chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinicopathological and biomolecular characteristics of stage IIB/IIC and stage IIIA colon cancer: Insight into the survival paradox

Kim

Lee

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background A survival paradox of stage IIB/IIC and IIIA colon cancer has been consistently observed throughout revisions of the TNM system. This study aimed to understand this paradox with clinicopathological and molecular differences. Methods Clinicopathological characteristics of patients with pathologically confirmed stage IIB/IIC or IIIA colon cancer were retrospectively reviewed from a database. Publicly available molecular data were retrieved, and intrinsic subtypes were identified and subjected to gene sets enrichment analysis (GSEA). Results Among the 159 patients included in the clinicopathological analysis, those at stage IIB/IIC had worse 3‐year disease‐free and overall survival than those at stage IIIA (59.3% vs 91.7%, P < 0.001 and 82.7% vs 98.5%, P < 0.001, respectively), even after adjusting for confounding factors. Data of 95 patients were retrieved from public databases, demonstrating a higher frequency of the microsatellite instable subtype in stage IIB/IIC. The consensus molecular subtype distribution pattern differed between the groups. The GSEA further suggested the protumor inflammatory reaction might be more prominent in stage IIB/IIC. Conclusions The survival paradox in colon cancer was confirmed and appears to be a multifactorial phenomenon not attributed to a single clinicopathologic factor. However, the greater molecular heterogeneity in stage IIB/IIC could contribute to the poor prognosis.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinicopathological and biomolecular characteristics of stage IIB/IIC and stage IIIA colon cancer: Insight into the survival paradox

Kim

Lee

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…However, increasing numbers of studies have reported that up to 20% of patients with stage II CRC will undergo tumor recurrence following resection [17,18]. There is a subgroup of patients with stage II CRC who have a worse clinical outcome than patients with stage III CRC presenting with up to two positive lymph nodes (stage IIIA) [17,18]. Also, there is still controversy regarding the role of treatment with adjuvant chemotherapy (AC) for patients with stage II CRC who are at high risk of tumor recurrence [19–21].…”

Section: Discussionmentioning

confidence: 99%

Stromal Expression of Vimentin Predicts the Clinical Outcome of Stage II Colorectal Cancer for High-Risk Patients

et al. 2017

View full text Add to dashboard Cite

BackgroundIncreased expression of vimentin in tissue samples from patients with colorectal cancer (CRC) has been previously demonstrated, but its prognostic significance remains controversial, and the clinical significance for patients with stage II CRC is still unknown. The aim of this study was to evaluate the expression of vimentin in CRC and its potential prognostic significance.Material/MethodsWe analyzed vimentin expression in 203 CRC tissue samples from patients with stage II cancer using immunohistochemistry, and correlated the findings with clinicopathological patient features. CRC-specific survival (CSS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. Univariate and multivariate analysis was performed using the Cox proportional hazards method for survival.ResultsVimentin expression was significantly correlated only with tumor (T) stage (p=0.024). Kaplan-Meier survival analysis indicated that vimentin expression could stratify the CSS and DFS of patients with stage II CRC at high risk (p=0.029, p=0.042, respectively), but not those of low-risk stage II patients (p=0.208, p=0.361, respectively). Univariate and multivariate analysis further revealed that stromal vimentin expression is an independent prognostic factor for CSS and DFS of high-risk stage II patients (p=0.043, p=0.022, respectively). Moreover, high-risk stage II patients with low stromal vimentin expression benefitted more from standard adjuvant chemotherapy than those with high stromal vimentin expression (CSS: p=0.012 vs. p=0.407; DFS: p=0.017 vs. p=0.420).ConclusionsOur study suggests that stromal vimentin expression is a promising indicator for survival prediction and adjuvant chemotherapy response in patients with stage II CRC with high-risk factors for recurrence.

show abstract

“…3 Similarly, Surveillance, Epidemiology, and End Results (SEER) studies highlighted that the survival rates of T1-2N1 patients were comparable to those in the T3N0 category, for both colon and rectal cancers. 4,5 Even though T4N0 and T1-2N1 cancers have been reported as small percentages of all colorectal neoplasms, 4,5 we would like to stress that a clear classification of risk groups could be crucial in identifying patients who could benefit (or conversely, not) of adjuvant treatments.…”

Section: Sub-staging Colorectal Cancers and Adjuvant Treatmentsmentioning

confidence: 99%

Sub-Staging Colorectal Cancers and Adjuvant Treatments

Lorenzon¹,

Balducci²,

Ferri³

2015

Journal of the American College of Surgeons

View full text Add to dashboard Cite

Survival Paradox Between Stage IIB/C (T4N0) and Stage IIIA (T1-2N1) Colon Cancer

Abstract: T4N0 colon cancer had significantly worse oncologic outcomes than T1-2N1 cancer regardless of adjuvant chemotherapy. The survival paradox may result from the biologic aggressiveness of T4N0 colon carcinomas.

Cited by 87 publications

References 20 publications

Clinicopathological and biomolecular characteristics of stage IIB/IIC and stage IIIA colon cancer: Insight into the survival paradox

Clinicopathological and biomolecular characteristics of stage IIB/IIC and stage IIIA colon cancer: Insight into the survival paradox

Stromal Expression of Vimentin Predicts the Clinical Outcome of Stage II Colorectal Cancer for High-Risk Patients

Sub-Staging Colorectal Cancers and Adjuvant Treatments

Contact Info

Product

Resources

About