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Surgery. 2016 Nov;160(5):1333-1343. doi: 10.1016/j.surg.2016.05.028. Epub 2016 Jul 15.

Positive surgical margins contribute to the survival paradox between patients with stage IIB/C (T4N0) and stage IIIA (T1-2N1, T1N2a) colon cancer.

Author information

1
Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA; Feist-Weiller Cancer Center, Shreveport, LA. Electronic address: qchu@lsuhsc.edu.
2
Louisiana Tumor Registry and Epidemiology, New Orleans, LA; School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.
3
Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA; Feist-Weiller Cancer Center, Shreveport, LA.

Abstract

BACKGROUND:

The underlying reasons for the survival paradox between stage IIB/C and stage IIIA colon cancer are elusive. We hypothesized that positive margins contribute to this paradox.

METHODS:

We evaluated a cohort of 16,471 patients with stage IIIA and stage IIB/C colon cancer from 709,583 cases diagnosed between 2003-2012 in the National Cancer Data Base. All patients had chemotherapy, and all stage IIB/C patients had ≥12 lymph nodes retrieved. Patients with stage IIIA were subdivided further into those with <12 lymph nodes retrieved and those with ≥12 lymph nodes retrieved. Univariable and multivariable survival analyses were used.

RESULTS:

The 5-year overall survival rate was 70.8% for stage IIB/C, 81.6% for stage IIIA with <12 lymph nodes, and 85.6% for stage IIIA with ≥12 lymph nodes (P < .0001). The 5-year overall survival rate was 84.3% for stage IIIA with no residual tumor, 74.8% for stage IIIA with residual tumor, 73.3% for stage IIB/C with no residual tumor, and 60.5% for stage IIB/C with residual tumor (P < .0001). Independent predictors (P < .01) of poor overall survival include stage IIB/C, advanced age, African American ethnicity, community cancer program, uninsured and Medicaid, low education level, high comorbidity index, and positive surgical margins.

CONCLUSION:

Positive surgical margins may contribute to the survival paradox between stage IIB/C and stage IIIA colon cancer patients.

PMID:
27425043
DOI:
10.1016/j.surg.2016.05.028
[Indexed for MEDLINE]

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