Clinicopathological and biomolecular characteristics of stage IIB/IIC and stage IIIA colon cancer: Insight into the survival paradox. Issue 3 (27th May 2019)

• Record Type: Journal Article
• Authors: Kim, Ho Seung; Kim, Kyeong Min; Lee, Sat Byol; Kim, Ga Ram; Han, Yoon Dae; Cho, Min Soo; Hur, Hyuk; Lee, Kang Young; Kim, Nam Kyu; Min, Byung Soh
• Is Part Of: Journal of surgical oncology. Volume 120:Issue 3(2019)
• Page Start: 423
• Page End: 430
• Publication Date: 2019-05-27
• Subjects: colon cancer -- stage IIB/IIC -- stage IIIA -- survival paradox; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.25515
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: A survival paradox of stage IIB/IIC and IIIA colon cancer has been consistently observed throughout revisions of the TNM system. This study aimed to understand this paradox with clinicopathological and molecular differences. Methods: Clinicopathological characteristics of patients with pathologically confirmed stage IIB/IIC or IIIA colon cancer were retrospectively reviewed from a database. Publicly available molecular data were retrieved, and intrinsic subtypes were identified and subjected to gene sets enrichment analysis (GSEA). Results: Among the 159 patients included in the clinicopathological analysis, those at stage IIB/IIC had worse 3‐year disease‐free and overall survival than those at stage IIIA (59.3% vs 91.7%, P < 0.001 and 82.7% vs 98.5%, P < 0.001, respectively), even after adjusting for confounding factors. Data of 95 patients were retrieved from public databases, demonstrating a higher frequency of the microsatellite instable subtype in stage IIB/IIC. The consensus molecular subtype distribution pattern differed between the groups. The GSEA further suggested the protumor inflammatory reaction might be more prominent in stage IIB/IIC. Conclusions: The survival paradox in colon cancer was confirmed and appears to be a multifactorial phenomenon not attributed to a single clinicopathologic factor. However, the greater molecular heterogeneity in stage IIB/IIC could contribute to the poor prognosis.