Ann Surg Treat Res.  2023 Feb;104(2):109-118. 10.4174/astr.2023.104.2.109.

Can clinicopathologic high-risk features in T3N0 colon cancer be reliable prognostic factors?

• Lee HG
• Kim YI
• Park IJ
• Lim SB
• Yu CS

• KMID: 2539225
• DOI: http://doi.org/10.4174/astr.2023.104.2.109

Abstract

Purpose
The purpose of this study was to assess the reliability and prognostic significance of the high-risk feature (HRF) in patients with T3N0 colon cancer.
Methods
We included 1,205 patients with pT3N0 colon cancer treated with curative radical resection between 2012 and 2016. HRF was defined as lymphovascular invasion, perineural invasion, poorly/undifferentiated histology, margin involvement, and preoperative obstruction. We investigated the relationships between the number and type of HRF and recurrence-free survival (RFS) and overall survival (OS), as well as the effect of adjuvant treatment.
Results
A total of 751 of the patients (62.3%) had more than 1 HRF and 515 of the patients (42.7%) underwent adjuvant treatment. Patients who had more than 2 HRFs had a significantly worse 5-year RFS and OS compared to patients who had neither HRF nor even one HRF. According to the findings of the multivariate analysis, the presence of multiple HRFs was a risk factor for a lower RFS and OS. When the quantity and type of HRF were taken into consideration in the multivariate analysis, adjuvant chemotherapy was not found to be linked with RFS or OS in patients with pT3N0 colon cancer.
Conclusion
In the present study, adjuvant treatment based on the current guideline of treatment indication was unable to enhance the prognosis of patients with pT3N0 colon cancer. The role of adjuvant treatment in T3N0 colon cancer must be examined with the HRF count in mind.

Keyword

Adjuvant chemotherapy; Colonic neoplasms; Risk factor; Survival

Figure

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  Fig. 1 Patient selection.

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  Fig. 2 Recurrence-free survival (A) and overall survival (B) according to adjuvant chemotherapy in T3N0 colon cancer.

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  Fig. 3 Recurrence-free survival (A–F) and overall survival (G–L) according to each type of high-risk features. PNI and obstruction showed significant association with recurrence-free survival and overall survival. LVI, lymphovascular invasion; PNI, perineural invasion; Margin, margin involvement by tumor; LN, lymph node; WD, well differentiated; MD, moderately differentiated; PD, poorly differentiated.

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  Fig. 4 Recurrence-free survival and overall survival according to the number of high-risk features (HRFs). Groups with ≥2 HRFs showed significantly lower recurrence-free survival and overall survival than those with 0–1 HRF.

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