Identification and Initial Validation of Maximal Tumor Area as a Novel Prognostic Factor for Overall and Disease-Free Survival in Patients With Resectable Colon Cancer: A Retrospective Study

Authors

Fei-Long Ning
Wan-Jie Gu
Lin-Zheng Dai
Wan-Ying Du
Yong-Ji Zeng
Jia-Kui Zhang
Masanobu Abe
Yan-Long Liu
Rui Zhang
Chun-Dong Zhang

Publication Date

11-1-2023

Journal

International Journal of Surgery

DOI

10.1097/JS9.0000000000000623

PMID

37526113

PMCID

PMC10651264

PubMedCentral® Posted Date

7-31-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Prognosis, Disease-Free Survival, Retrospective Studies, Neoplasm Staging, Colonic Neoplasms, Neoplasms, Second Primary, colon cancer, prognostic factor, prognostic model, tumor area, tumor size

Abstract

BACKGROUND: The tumor area may be a potential prognostic indicator. The present study aimed to determine and validate the prognostic value of tumor area in curable colon cancer.

METHODS: This retrospective study included a training and validation cohorts of patients who underwent radical surgery for colon cancer. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were identified using Cox proportional hazards regression models. The prognostic discrimination was evaluated using the integrated area under the receiver operating characteristic curves (iAUCs) for prognostic factors and models. The prognostic discrimination between tumor area and other individual factors was compared, along with the prognostic discrimination between the tumor-node-metastasis (TNM) staging system and other prognostic models. Two-sample Wilcoxon tests were carried out to identify significant differences between the two iAUCs. A two-sided P

RESULTS: A total of 3051 colon cancer patients were included in the training cohort and 872 patients in the validation cohort. Tumor area, age, differentiation, T stage, and N stage were independent prognostic factors for both OS and DFS in the training cohort. Tumor area had a better OS and DFS prognostic discrimination characteristics than T stage, maximal tumor diameter, differentiation, tumor location, and number of retrieved lymph nodes. The novel prognostic model of T stage + N stage + tumor area (iAUC for OS, 0.714, P

CONCLUSIONS: Tumor area was identified as an independent prognostic factor for both OS and DFS in curable colon cancer patients, and in cases with an adequate number of retrieved lymph nodes. The novel prognostic model of combining T stage, N stage, and tumor area may be an alternative to the current TNM staging system.