The survival and clinicopathological differences between patients with stage IIIA and stage II rectal cancer: An analysis of 12,036 patients in the SEER database

Abstract

BackgroundStage IIIA rectal cancer has distinctive oncological features, including limited depth of intestinal wall invasion and early regional lymph node metastasis. We aim to compare survival outcomes and clinicopathological features for stage IIIA rectal cancer with those for stage II rectal cancer.MethodWe analyzed patients with stage II or stage IIIA rectal cancer treated with surgery without receiving preoperative radiotherapy based on data from the US Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2003. Survival curves were plotted using the Kaplan-Meier method. Multivariate Cox proportional analyses were utilized to analyze independent prognostic factors for cancer-specific survival (CSS).ResultsWe included 12,036 rectal cancer patients (10,132 stage II and 1,904 stage IIIA) from the SEER database. Patients with stage IIIA rectal cancer had smaller tumor size than patients with stage II rectal cancer. A multivariate analysis suggested that compared with patients with stage IIIA rectal cancer, patients with stage II disease were more likely to have more unfavorable CSS (HR 1.195, 95% CI 1.079-1.324, p=0.001). When stage II rectal cancer was further analyzed as stage IIA, IIB and IIC rectal cancer, the multivariate analysis indicated that compared with patients with stage IIIA rectal cancer, patients with stage IIA rectal cancer (HR 1.113, 95% CI 1.003-1.235, p=0.044), stage IIB rectal cancer (HR 1.493, 95% CI 1.267-1.758, p<0.001) and stage IIC rectal cancer (HR 2.712, 95% CI 2.319-3.171, p<0.001) were also more likely to exhibit more unfavorable CSS.ConclusionPatients with stage IIIA rectal cancer had more favorable survival outcomes and smaller tumor size compared with patients with stage II rectal cancer.

Poorer Oncologic Outcome of Good Responders to PCRT With Remnant Lymph Nodes Defies the Oncologic Paradox in Patients With Rectal Cancer

“…Better prognosis had been paradoxically observed in patients with pT0-2Nþ disease despite being staged higher than patients with pT3N0 disease in the past. 1,2 In our study, ypNþ status predicted a worse prognosis even in tumors with good response to PCRT (ie, ypT0-2 tumors). The RFS and OS of patients with ypT0-2Nþ disease deteriorated to the extent that they were comparable to those of patients with ypT4N0 disease (67.3% vs. 63%; P ¼ .361).…”

“…Patients with stage IIIA rectal cancer not treated with PCRT reportedly have better survival outcomes compared with those in patients with stages IIB-C diseases, nearing that in patients with stage I disease in previous reports analyzing the SEER database. 1,2 The current AJCC staging system was criticized on this note for seemingly overestimating the influence of LN metastasis.…”

“…There is growing evidence that postoperative pathologic nodal status is a key prognostic factor for oncologic outcome in patients with rectal cancer treated with PCRT. [1][2][3][4] In an Italian study of 82 patients with locally advanced resectable extraperitoneal rectal cancer (LARC), 8 ypN status was the most significant prognostic factor among patients with ypT3-4 disease, whereas a study by a Korean group that included 382 patients with LARC 9 reported ypN status as the strongest prognostic factor in patients with ypT0 disease.…”

“…There have been studies reporting survival paradox among patients with colorectal cancer in which those with cancer confined within the bowel wall but with metastatic lymph nodes (LNs) in the mesorectum, despite being staged higher, have better oncologic outcome than that of patients with tumors that infiltrate the bowel wall but without metastatic LNs, 1,2 although the American Joint Committee on Cancer (AJCC) staging system is the one of the most powerful prognostication measurements. With the advent and wide application of preoperative chemoradiotherapy (PCRT) for locally advanced rectal cancer, it remains unclear whether the same weight should be placed on pathologic LN metastasis in predicting the prognosis of patients who receive PCRT.…”

Survival Contradiction Between Stage IIA and Stage IIIA Rectal Cancer: A Retrospective Study

“…According to heterogeneous oncological outcomes, stage III rectal cancer is subdivided into stage IIIA, stage IIIB and stage IIIC rectal cancer in the 7 th AJCC cancer staging manual 3 . Although the 7 th edition AJCC cancer staging system has some improvements over the 6 th edition 4 , 5 , a survival contradiction between stage IIIA and stage II colorectal cancer still exists in the current staging system 6 - 8 . Patients with stage IIIA colorectal cancer showed better prognosis than those with stage IIB and stage IIC disease in several studies 7 - 9 .…”