Smaller tumor size is associated with poor survival in T4b colon cancer

Table 1 Demographics of patients from the Surveillance, Epidemiology and End Results database with T4bN0-2M0 colon cancer, stratified by tumor size n (%)

Characteristic	Tumor size (cm)				P value
	Total (n = 1734)	≤4.0 (n = 274)	4.0-7.0 (n = 653)	≥7.0 (n = 807)
Median follow-up (mo)	43	33	43	50
IQR	15-107	12-92	17-105	14-114
Sex					0.395
Male	857 (49.4)	131 (47.8)	313 (47.9)	413 (51.2)
Female	877 (50.6)	143 (52.2)	340 (52.1)	394 (48.8)
Year of diagnosis					0.867
1988-1999	856 (49.4)	137 (50.0)	317 (48.5)	402 (49.8)
2000-2003	878 (50.6)	137 (50.0)	336 (51.5)	405 (50.2)
Age at diagnosis (yr)					0.330
≤ 60	785 (45.3)	130 (47.4)	281 (43.0)	374 (46.3)
> 60	949 (54.7)	144 (52.6)	372 (57.0)	433 (53.7)
Primary site					0.187
Right colon	1103 (63.6)	176 (64.2)	398 (60.9)	529 (65.6)
Left colon	631 (36.4)	98 (35.8)	255 (39.1)	278 (34.4)
Race					0.145
White	1386 (80.0)	212 (77.4)	530 (81.2)	644 (79.8)
Black	195 (11.2)	41 (15.0)	61 (9.3)	93 (11.5)
Other1	153 (8.8)	21 (7.6)	63 (9.5)	69 (8.7)
Histological type					0.016
Adenocarcinoma	1351 (77.9)	223 (81.4)	525 (80.4)	603 (74.7)
Mucinous adenocarcinoma	341 (19.7)	42 (15.3)	118 (18.1)	181 (22.4)
Signet-ring cell carcinoma	42 (2.4)	9 (3.3)	10 (1.5)	23 (2.9)
Pathology grade					0.001
High/Moderate	1158 (66.8)	189 (69.0)	466 (71.4)	503 (62.3)
Poor/Undifferentiated	576 (33.2)	85 (31.0)	187 (28.6)	304 (37.7)
N stage					0.001
N0	725 (41.8)	93 (34.0)	255 (39.0)	377 (46.7)
N1	460 (26.5)	74 (27.0)	188 (28.8)	198 (24.5)
N2	549 (31.7)	107 (39.0)	210 (32.2)	232 (28.8)
LNH					0.013
≤ 18	938 (54.1)	157 (57.3)	375 (57.4)	406 (50.3)
> 18	796 (45.9)	117 (42.6)	278 (42.6)	401 (49.7)

¹Includes Native American, Asian, Pacific Islander and Unknown. IQR: Interquartile range; LNH: Number of lymph nodes harvested.

Table 2 Univariate analyses of patients from the Surveillance, Epidemiology and End Results database with T4bN0-2M0 colon cancer, stratified by tumor size

Cut-off	n	5-yr CSS	Log-rank χ2	P value
≤ 3	94	35.9%	3.710	0.054
> 3	1640	48.7%
≤ 4	274	37.1%	15.214	< 0.001
> 4	1460	50.0%
≤ 5	542	40.8%	18.235	< 0.001
> 5	1192	51.2%
≤ 6	845	43.3%	14.118	< 0.001
> 6	889	52.4%
≤ 7	1066	45.1%	7.303	0.007
>7	668	52.5%
≤ 8	1284	46.3%	3.877	0.049
> 8	450	52.5%
≤ 9	1422	46.9%	2.270	0.132
> 9	312	52.8%
≤ 10	1541	47.0%	5.061	0.024
> 10	193	55.8%

Table 3 Univariate and multivariate survival analyses of patients from the Surveillance, Epidemiology and End Results database with T4bN0-2M0 colon cancer

Variable	Univariateanalysis		Multivariateanalysis
	5-yr CSS	P value	HR	95%CI	P value
Sex		0.404			NI
Male	46.7%
Female	49.1%
Year of diagnosis		0.339			NI
1988-1999	49.4%
2000-2003	46.6%
Race		0.184			NI
White	48.9%
Black	41.1%
Other1	48.6%
Age at diagnosis (yr)		< 0.001			< 0.001
≤ 60	51.7%		1.000	reference
> 60	44.8%		1.309	1.148-1.492
Primary site		0.001			0.061
Right colon	45.1%		1.000	reference
Left colon	52.9%		0.875	0.761-1.006
Histological type		< 0.001			0.100
Adenocarcinoma	48.5%		1.000	reference
Mucinous adenocarcinoma	49.7%		1.008	0.848-1.197
Signet-ring cell carcinoma	17.2%		1.518	1.037-2.222
Pathology grade		< 0.001			0.002
High	67.8%		1.000	reference
Moderate	51.4%		1.530	1.127-2.077
Poor	38.6%		1.729	1.258-2.376
Undifferentiated	25.0%		2.526	1.389-4.596
N stage		< 0.001			< 0.001
N0	69.5%		1.000	reference
N1	43.7%		1.857	1.559-2.212
N2	22.5%		3.600	3.056-4.239
LNH		0.001			0.009
≤ 18	43.5%		1.000	reference
> 18	53.2%		0.841	0.738-0.959
Tumor size, cm		< 0.001			0.024
≤ 4.0	37.1%		1.000	reference
4.0-7.0	47.0%		0.820	0.683-0.985	0.034
≥ 7.0	52.5%		0.775	0.645-0.932	0.007

¹Includes Native American, Asian, Pacific Islander and Unknown. CSS: Cancer-specific survival; LNH: Number of lymph nodes harvested; NI: Not included in the multivariate survival analysis.

Table 4 Univariate and multivariate survival analyses of patients in the Surveillance, Epidemiology and End Results database with T4bN0M0 colon cancer

Variable	Univariateanalysis		Multivariateanalysis
	5-yr CSS	P value	HR	95%CI	P value
Sex		0.443			NI
Male	67.7%
Female	71.2%
Year of diagnosis		0.473			NI
1988-1999	71.9%
2000-2003	66.7%
Race		0.388			NI
White	70.0%
Black	62.2%
Other1	73.0%
Primary site		0.819			NI
Right colon	70.1%
Left colon	68.6%
Histological type		0.401			NI
Adenocarcinoma	69.0%
Mucinous adenocarcinoma	72.1%
Signet-ring cell carcinoma	40.0%
Pathology grade		0.552			NI
High	80.6%
Moderate	68.5%
Poor	66.0%
Undifferentiated	66.7%
Age at diagnosis (yr)		0.002			0.004
≤ 60	74.1%		1.000	reference
> 60	65.5%		1.441	1.127-1.841
LNH		0.029			0.063
≤ 18	64.3%		1.000	reference
> 18	75.1%		0.795	0.624-1.013
Tumor size, cm		0.024			0.048
≤ 4.0	58.4%		1.000	reference
4.0-7.0	69.3%		0.790	0.554-1.127	0.194
≥ 7.0	72.4%		0.656	0.464-0.926	0.017

¹Includes Native American, Asian, Pacific Islander and Unknown. CSS: CANCER-specific survival; LNH: NUMBER of lymph nodes harvested; NI: NOT included in the multivariate survival analysis.

Table 5 Demographics of patients from the Fudan University Shanghai Cancer Center database with T4bN0-2M0 colon cancer, according to tumor size n (%)

Characteristic	Tumor size (cm)				P value
	Total (n = 101)	≤4.0 (n = 18)	4.0-7.0 (n = 39)	≥7.0 (n = 44)
Median follow-up (mo)	49	46	51	44
IQR	33-62	27-72	31-61	33-62
Sex					0.582
Male	59 (58.4)	9 (50.0)	22 (56.4)	28 (63.6)
Female	42 (41.6)	9 (50.0)	17 (43.6)	16 (36.4)
Age at diagnosis (yr)					0.245
≤ 60	33 (32.7)	3 (16.7)	13 (33.3)	17 (38.6)
> 60	68 (67.3)	15 (83.3)	26 (66.7)	27 (61.4)
Primary site					0.668
Right colon	50 (49.5)	8 (44.4)	18 (46.2)	24 (54.5)
Left colon	51 (50.5)	10 (55.6)	21 (53.8)	20 (45.5)
Histology type					0.262
Adenocarcinoma	88 (87.1)	16 (88.9)	35 (89.7)	37 (84.1)
Mucinous adenocarcinoma	10 (9.9)	1 (5.6)	2 (5.1)	7 (15.9)
Signet-ring cell carcinoma	3 (3.0)	1 (5.6)	2 (5.1)	0 (0.0)
Pathology grade					0.567
High/Moderate	72 (71.3)	11 (61.1)	29 (74.4)	32 (72.7)
Poor/Undifferentiated	29 (28.7)	7 (38.9)	10 (25.6)	12 (27.3)
N stage					0.210
N0	43 (42.6)	4 (22.2)	20 (51.3)	19 (43.2)
N1	34 (33.7)	10 (55.6)	10 (25.6)	14 (31.8)
N2	24 (23.8)	4 (22.2)	9 (23.1)	11 (25.0)
LNH					0.109
≤ 18	56 (55.4)	14 (77.8)	20 (51.3)	22 (50.0)
> 18	45 (44.6)	4 (22.2)	19 (48.7)	22 (50.0)
Lymphovascular invasion					0.176
Positive	37 (36.6)	10 (55.6)	12 (30.8)	15 (34.1)
Negative	64 (63.4)	8 (44.4)	27 (69.2)	29 (65.9)
Perineural invasion					0.906
Positive	24 (23.8)	5 (27.8)	9 (23.1)	10 (22.7)
Negative	77 (76.2)	13 (72.2)	30 (76.9)	34 (77.3)

IQR: Interquartile range; LNH: Number of lymph nodes harvested; FUSCC: Fudan University Shanghai Cancer Centre.