Tumor size as a prognostic factor in patients with stage IIa colon cancer

Santullo, Francesco; Biondi, Alberto; Cananzi, Ferdinando Carlo Maria; Fico, Valeria; Tirelli, Flavio; Ricci, Riccardo; Rizzo, Gianluca; Coco, Claudio; Mattana, Claudio; D’Ugo, Domenico; Persiani, Roberto

doi:10.1016/j.amjsurg.2017.03.038

Cited by 27 publications

(24 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies suggested that solid tumors including gastrointestinal tumors can obtain the potential of dissemination during the process of growing both horizontally and vertically [16]. Currently, although many investigators have confirmed the negative prognostic role of tumor size, the value of tumor size in survival prediction is still underappreciated [3][4][5][6][7][8][9][10][11][12][13]. However, the vertical growth index reflected by T stage has been established as one of the dominating prognostic factors and has been incorporated into the widely accepted TNM staging system in colon cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Tumor size, defined as the maximal horizontal tumor diameter, has been studied for decades, and large horizontal tumor extent has generally been considered to be negatively associated with prognosis in many solid tumors, including colonic malignancies [3][4][5][6][7][8][9][10][11][12][13]. However, because of the vertical index of infiltration depth reflected by T stage, tumor size has not been recognized as a valuable factor in predicting prognosis in colon cancer.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Dai

Xiang

et al. 2019

The Oncologist

View full text Add to dashboard Cite

Background The role of horizontal growth index of tumor size in survival prediction is still underappreciated in colon cancer because of the identification of vertical infiltration index reflected by T stage. We sought to reveal the impact of T stage on the prognostic and predictive value of tumor size in colon cancer. Materials and Methods Data of patients with stage I–III colon cancer were extracted from Surveillance, Epidemiology, and End Results Program (SEER) and Fudan University Shanghai Cancer Center (FUSCC) databases. Harrell's concordance index (c‐index) and time‐dependent receiver operating characteristic curve (ROC) were used to analyze the discriminative ability of prognostic factors. Results Stratified analyses based on T stage found that the increase of T stage significantly and negatively repressed the effect of tumor size on death and recurrence risk. In addition, tumor size showed the greatest hazard ratio of cancer‐specific death and relapse in T1 colon cancer. Even more importantly, the discriminatory ability of tumor size outperformed any other widely accepted prognostic clinical features in predicting cancer‐specific survival (SEER: c‐index 0.637, area under the ROC [AUC] 0.649; FUSCC: c‐index 0.673, AUC 0.686) and disease‐free survival (FUSCC: c‐index 0.645, AUC 0.656) in T1 stage colon cancer. Conclusion Tumor size is a critical clinical factor with considerable prognostic and predictive value for T1 colon cancer, and it should be selectively incorporated into the current staging system to facilitate prediction of death and recurrence risk. Implications for Practice To date, no consensus has been reached about the prognostic and predictive value of tumor size in colon cancer. Although tumor size is an independent prognostic factor for patients with colon cancer, the impact of tumor size on death or recurrence risk decreased notably with the increase of T stage. More importantly, the discriminative ability of tumor size outperformed any other clinical factors including N stage in patients with T1 colon cancer. Therefore, tumor size should be recommended to be incorporated into current staging systems to facilitate prognosis prediction for patients with T1 colon cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Dai

Xiang

et al. 2019

The Oncologist

View full text Add to dashboard Cite

show abstract

“…Clinicopathological parameters, including sex, age, and the carcinoembryonic antigen (CEA) level, were collected before the surgery. In addition, pathological reports for tumor location, histological grade, invasive depth and tumor diameter (cut-off 4 cm) ( 18 ) were registered. The postoperative adjuvant therapies were checked.…”

Section: Methodsmentioning

confidence: 99%

A persistent high neutrophil‑to‑lymphocyte ratio predicts poor prognosis in patients with colorectal cancer undergoing resection

Cui

Yan

2020

Mol Clin Oncol

View full text Add to dashboard Cite

The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) has been reported in colorectal cancer (CRC); however, its variation and corresponding predicative value in patients undergoing resection remain largely unknown. In the present study, data from 146 patients with CRC were retrospectively collected, optimal cutoff points for preoperative and postoperative low and high NLRs were set, and ΔNLR was calculated. Subsequently, patients were classified into low-low, low-high, high-low and high-high subgroups based on the cutoff points, and their progression-free survival (PFS) was determined. A Cox proportional hazard model was applied to calculate the prognostic value of all factors. The results demonstrated that both preoperative and postoperative NLRs (pre-NLR and post-NLR) but not ΔNLR could predict PFS with optimal cutoff points of 2.39 and 2.96, respectively. For predicting PFS, the pre-NLR had a sensitivity and specificity of 48.80 and 79.50%, respectively, and the post-NLR had a sensitivity and specificity of 63.20 and 56.20%, respectively. Significant differences were identified between low and high pre-NLRs in terms of histological grade (P<0.01) and tumor diameter (P<0.01); however, such differences were only found in terms of age (P<0.01) for low and high post-NLRs. The PFS of patients in the low-low, low-high, high-low and high-high subgroups was 50.30±21.36, 43.67±22.78, 31.06±25.56 and 29.87±24.13 months, respectively, and patients in the high-high subgroup had the worst PFS (P<0.01). Preoperative CEA level, invasive depth, node involvement, distant metastasis and preoperative NLR were independent prognostic factors. In conclusion, a persistently high NLR for patients with CRC undergoing resection was associated with poor prognosis.

show abstract

“…However, the tumor size was not involved in the TNM staging system of CRC and was reported to have no effects on clinical outcomes in a series of studies 8, 9. Recently, several researches revealed that larger tumor size was significantly associated with complications, metastasis, high recurrence and poor prognosis of CRC 10-13, whereas several other studies showed that patients with smaller tumor size had worse prognosis 14-16. Thus, whether the tumor size is a prognostic indicator and the exact roles of the tumor size on the prognosis and recurrence in CRC patients remain controversial and need further investigation.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of the Tumor Size in Resectable Colorectal Cancer with Different Primary Locations: A Retrospective Study with the Propensity Score Matching

Li¹,

An²,

Ma³

et al. 2019

J. Cancer

View full text Add to dashboard Cite

Objective: To investigate the prognostic value of the tumor size in colorectal cancer (CRC) patients with different primary tumor locations.Patients and methods: We retrospectively recruited 3971 stage I-III CRC patients with curative resection. The propensity score matching technique was conducted to reduce the selection bias, producing a propensity score matched cohort of 1347 pairs of patients based on the tumor size (≤4 cm and >4 cm groups). Kaplan-Meier survival analyses and univariate and multivariate analyses were used to compare the overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) between the two groups. Subgroup analyses which were stratified by primary tumor locations and several other baseline variables were also performed for conformation.Results: In the propensity score matched cohort, the Kaplan-Meier survival curves revealed that patients with a tumor size less than 4 cm had similar OS, CSS and DFS, compared to patients with a tumor size greater than 4 cm. While in multivariate analyses, the smaller tumor size was an independent risk factor for CSS (HR, 1.275; 95% CI, 1.006-1.616; P=0.045). Subgroup analyses based on primary tumor locations further suggested that the smaller tumor size was significantly associated with worse OS (HR, 2.455; 95% CI, 1.297-4.649; P=0.006) and CSS (HR, 2.493; 95% CI, 1.202-5.174; P=0.014) in patients with right-side colon cancers (RCC).Conclusions: Our propensity matching score study indicated that the smaller tumor size was an independent risk factor for CSS in patients with stage I-III CRC, and for OS and CSS in patients with RCC.

show abstract

Tumor size as a prognostic factor in patients with stage IIa colon cancer

Cited by 27 publications

References 31 publications

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

A persistent high neutrophil‑to‑lymphocyte ratio predicts poor prognosis in patients with colorectal cancer undergoing resection

Prognostic Value of the Tumor Size in Resectable Colorectal Cancer with Different Primary Locations: A Retrospective Study with the Propensity Score Matching

Contact Info

Product

Resources

About