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

Abstract

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.

Keywords: Cancer-specific survival; Colon cancer; Disease-free survival; T1 stage; Tumor size.

Figure 1

Impact of T stage on the hazard ratio of tumor size in predicting CSS and DFS of colon cancer. (A): CSS in SEER database. (B): CSS in FUSCC database. (C): DFS in FUSCC database. Abbreviations: CSS, cancer‐specific survival; DFS, disease‐free survival; FUSCC, Fudan University Shanghai Cancer Center; SEER, Surveillance, Epidemiology, and End Results.

Figure 2

Construction and validation of tumor size–based nomogram in T1 colon cancer. (A): Tumor size–based nomogram in Surveillance, Epidemiology, and End Results (SEER) data set. (B): Nomogram without tumor size in SEER. (C): Time‐dependent ROC of the nomogram with or without tumor size. (D): Validation and prediction performance of the nomogram with or without tumor size in Fudan University Shanghai Cancer Center cohort. Abbreviations: AUC, area under the ROC; LNH, lymph node harvest; ROC, receiver operating characteristic curve.