Infiltrating Tumor Border Configuration is a Poor Prognostic Factor in Stage II and III Colon Adenocarcinoma
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ORIGINAL ARTICLE – TRANSLATIONAL RESEARCH
Infiltrating Tumor Border Configuration is a Poor Prognostic Factor in Stage II and III Colon Adenocarcinoma Yasmeen Z. Qwaider, MD1, Naomi M. Sell, MD, MHS1, Caitlin E. Stafford, BA1, Hiroko Kunitake, MD, MPH1, James C. Cusack, MD1, Rocco Ricciardi, MD, MPH1, Liliana G. Bordeianou, MD1, Vikram Deshpande, MD, PhD2, Robert N. Goldstone, MD1, Christy E. Cauley, MD, MPH1, and David L. Berger, MD1 1
Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA; 2Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
ABSTRACT Introduction. Tumor border configuration (TBC) is a prognostic factor in colorectal adenocarcinoma; however, the significance of TBC is not well-documented in colon adenocarcinoma alone. Objective. Our aim was to study the effect of TBC on overall and disease-free survival in stage II and III colon adenocarcinoma. Methods. We included patients with stage II and III colon adenocarcinoma who were surgically treated at a tertiary medical center between 2004 and 2015, to ensure longterm follow-up. Patients were stratified into four groups based on stage and TBC. A Cox regression was used to model the relationship of groups while accounting for relevant confounders. Results. The cohort consisted of 700 patients (371 stage II and 329 stage III). Infiltrating TBC was statistically significantly associated with stage (p \ 0.001) and extramural vascular invasion (p \ 0.001), but not histologic grade (p = 0.7). Compared with pushing TBC, infiltrating TBC increased the hazard of death by a factor of 1.8 [95% confidence interval (CI) 1.4–2.4; p \ 0.001] and 1.7 (95%
This work was presented as an oral presentation at the Society of Surgical Oncology (SSO) annual meeting, August 2020. Ó Society of Surgical Oncology 2020 First Received: 10 July 2020 Accepted: 3 October 2020 D. L. Berger, MD e-mail: [email protected]
CI 1.3–2.2; p \ 0.001). The hazard of death in patients with stage II disease (infiltrating TBC) or stage III disease (pushing TBC) was not significantly different (adjusted hazard ratio 1.1, 95% CI 0.7–1.7; p = 0.8). Conclusion. Infiltrating TBC is a high-risk feature in patients with stage II and III colon adenocarcinoma. Stage II disease patients with infiltrating TBC and who are nodenegative should be considered for adjuvant chemotherapy.
In colorectal cancer, prognosis and treatment are often determined by the histopathological findings of the tumor after surgical resection.1 The TNM classification (which includes extent of invasion, regional lymph node involvement, and distant metastasis) is the gold standard for categorizing tumors.2 Typically, adjuvant chemotherapy is administered to most node-positive tumors, but not all node-negative tumors.1 The decision to start adjuvant therapy in node-negative disease is driven by the presence of a certain set of risk factors that categorize node-negative t
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