Association of tumor size in pathological T4 colorectal cancer with desmoplastic reaction and prognosis

Abstract

Background Tumor size in pathological T4 (pT4) colorectal cancer (CRC) is associated with oncological prognosis; however, its relation to epithelial‐mesenchymal transition (EMT)‐associated histology is unclear. We aimed to investigate the association of tumor size with oncological prognosis and EMT. Methods We performed a retrospective analysis of 95 patients with primary CRC who underwent radical surgery and were consecutively diagnosed with pT4. Results Both 3‐y disease‐free survival (DFS) and cancer‐specific survival (CSS) were significantly higher in patients with tumor size ≥50 mm than in those with tumor size <50 mm (P = .009 and P = .011, respectively). The independent factors identified in the multivariate analysis for DFS were pathological lymph node metastasis (hazard ratio [HR], 2.551; 95% confidence interval [CI], 1.031–6.315; P = .043), distant metastasis (HR, 2.511; 95% CI, 1.140–5.532; P = .022), tumor size (HR, 0.462; 95% CI, 0.234–0.913; P = .026), and adjuvant chemotherapy (HR, 0.357; 95% CI, 0.166–0.766; P = .008). The independent factors identified in multivariate analysis for CSS were tumor location (HR, 10.867; 95% CI, 2.539–45.518; P = .001) and tumor size (HR, 0.067; 95% CI, 0.014–0.321; P < .001). In pT4 CRC, smaller tumor size was associated with nonmature desmoplastic reaction and EMT‐related histology. Conclusions Tumor size ≥50 mm was associated with a better DFS and CSS than that of <50 mm, in patients with pT4 CRC. Smaller tumor size with advanced invasion likely reflects a more biologically aggressive phenotype in pT4 CRC.

Impact of tumor size on overall survival and cancer-specific survival of early-onset colon and rectal cancer: a retrospective cohort study

“…This finding contrasted with other stages and highlighted the nuanced impact of tumor size on survival, depending on the stage of the disease. After a thorough literature search, we found that previous studies have revealed this seemingly paradoxical finding [ 23 , 32 – 37 ]. For example, Huang et al analysed 7719 patients with stage II colon cancer from the SEER database and indicated that patients with smaller tumors were associated with decreased CSS compared with those with larger tumors [ 32 ].…”

“…Their study was limited by the small sample size. In addition, Shiraishi et al performed a retrospective study of 95 patients with pT4 CRC and demonstrated that tumor size ≥ 50 mm was associated with a better CSS than that of < 50 mm [ 23 ]. This contrasting view should be interpreted with caution because only 95 patients were included in the analysis.…”

“…Despite this growing body of research, there remains a significant gap in our understanding of how tumor size affects survival outcomes in young patients with CRC. Although tumor size has been recognized as a prognostic factor for CRC, the results were inconsistent [ 19 – 23 ]. To the best of our knowledge, no study has investigated the impact of tumor size on survival outcomes in early-onset CRC.…”