Tumor size predicts long-term survival in colon cancer: an analysis of the National Cancer Data Base

Saha, Sukamal; Shaik, Mohammed; Johnston, Gregory; Saha, Supriya K.; Berbiglia, Lindsay; Hicks, Micheal; Gernand, Jill; Grewal, Sandeep Singh; Arora, Madan L.; Wiese, David

doi:10.1016/j.amjsurg.2014.12.008

Cited by 95 publications

(76 citation statements)

References 10 publications

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“…Therefore, although both are a growth index, vertical infiltration seems to be much more important than horizontal proliferation, which might explain why the prognostic prediction value of tumor size dwindled as the T stage became more advanced. Like many previous studies [6,8,10,17], we confirmed the independent predictive effect of tumor size in prognosis among all patients with stage I-III colon cancer. However, the HR of tumor size decreased gradually with the increase of T stage.…”

Section: Discussionsupporting

confidence: 90%

“…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%

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

Dai

Xiang

et al. 2019

The Oncologist

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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

Dai

Xiang

et al. 2019

The Oncologist

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“…Numerous studies have shown that measurements of tumor volume are critically important to monitor treatment efficacy . Most investigations with neoadjuvant treatment have quantified tumor extent or size by simply performing diameter measurements in one or two dimensions .…”

Section: Discussionmentioning

confidence: 99%

Biocompatible astaxanthin as novel contrast agent for biomedical imaging

Nguyen

Park

et al. 2016

J. Biophotonics

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Photoacoustic imaging (PAI) is a hybrid imaging modality with high resolution and sensitivity that can be beneficial for cancer staging. Due to insufficient endogenous photoacoustic (PA) contrast, the development of exogenous agents is critical in targeting cancerous tumors. The current study demonstrates the feasibility of marine-oriented material, astaxanthin, as a biocompatible PA contrast agent. Both silicon tubing phantoms and ex vivo bladder tissues are tested at various concentrations (up to 5 mg/ml) of astaxanthin to quantitatively explore variations in PA responses. A Q-switched Nd : YAG laser (λ = 532 nm) in conjunction with a 5 MHz ultrasound transducer is employed to generate and acquire PA signals from the samples. The phantom results presented that the PA signal amplitudes increase linearly with the astaxanthin concentrations (threshold detection = 0.31 mg/ml). The tissue injected with astaxanthin yields up to 16-fold higher PA signals, compared with that with saline. Due to distribution of the injected astaxanthin, PAI can image the margin of astaxanthin boles as well as quantify their volume in 3D reconstruction. Further investigations on selective tumor targeting are required to validate astaxanthin as a potential biocompatible contrast agent for PAI-assisted bladder cancer detection.

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“…However, it is also reported that larger number of lymph node is more frequently observed in CRC with a greater diameter, poor histology, a proximal location and a deeper depth of penetration as well [3, 12, 13]. These factors tend to exert adverse rather than favorable effects on survival of patients with CRC [3, 23]. The contradiction indicates that the relationship between increased LNC and prolonged survival may be not straightforward as expected.…”

Section: Introductionmentioning

confidence: 99%

A Nomogram to Predict Adequate Lymph Node Recovery before Resection of Colorectal Cancer

et al. 2016

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Increased lymph node count (LNC) has been associated with prolonged survival in colorectal cancer (CRC), but the underlying mechanisms are still poorly understood. The study aims to identify new predictors and develop a preoperative nomogram for predicting the probability of adequate LNC (≥ 12). 501 eligible patients were retrospectively selected to identify clinical-pathological factors associated with LNC ≥ 12 through univariate and multivariate logistic regression analyses. The nomogram was built according to multivariate analyses of preoperative factors. Model performance was assessed with concordance index (c-index) and area under the receiver operating characteristic curve (AUC), followed by internal validation and calibration using 1000-resample bootstrapping. Clinical validity of the nomogram and LNC impact on stage migration were also evaluated. Multivariate analyses showed patient age, CA19-9, circulating lymphocytes, neutrophils, platelets, tumor diameter, histology and deposit significantly correlated with LNC (P < 0.05). The effects were marginal for CEA, anemia and CRC location (0.05 < P < 0.1). The multivariate analyses of preoperative factors suggested decreased age, CEA, CA19-9, neutrophils, proximal location, and increased platelets and diameter were significantly associated with increased probability of LNC ≥ 12 (P < 0.05). The nomogram achieved c-indexes of 0.75 and 0.73 before and after correction for overfitting. The AUC was 0.75 (95% CI, 0.70–0.79) and the clinically valid threshold probabilities were between 10% and 60% for the nomogram to predict LNC < 12. Additionally, increased probability of adequate LNC before surgery was associated with increased LNC and negative lymph nodes rather than increased positive lymph nodes, lymph node ratio, pN stages or AJCC stages. Collectively, the results indicate the LNC is multifactorial and irrelevant to stage migration. The significant correlations with preoperative circulating markers may provide new explanations for LNC-related survival advantage which is reflected by the implication of regional and systemic antitumor immune responses.

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Tumor size predicts long-term survival in colon cancer: an analysis of the National Cancer Data Base

Cited by 95 publications

References 10 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

Biocompatible astaxanthin as novel contrast agent for biomedical imaging

A Nomogram to Predict Adequate Lymph Node Recovery before Resection of Colorectal Cancer

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