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Prognostic Impact of pT Stage and Peritoneal Invasion in Locally Advanced Colon Cancer

Baguena, Gloria, M.D., Ph.D.1; Pellino, Gianluca, Ph.D., E.B.S.Q.-c, M.D.1; Frasson, Matteo, Ph.D., E.B.S.Q-c., M.D.1; Roselló, Susana, M.D., Ph.D.2; Cervantes, Andres, M.D., Ph.D.2; García-Granero, Alvaro, M.D., Ph.D.1; Giner, Francisco, M.D., Ph.D.3; García-Granero, Eduardo, Ph.D., E.B.S.Q.-c, M.D.1

Diseases of the Colon & Rectum: June 2019 - Volume 62 - Issue 6 - p 684–693
doi: 10.1097/DCR.0000000000001367
Original Contributions: Colorectal Cancer
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BACKGROUND: TNM stage has been identified as an independent variable for local recurrence and survival after colon cancer resection. It is still unclear whether peritoneal invasion (pT4a) is a risk factor for adverse oncologic outcome or whether these patients have better results compared with contiguous organs infiltration (pT4b), independent from nodal status (pN).

OBJECTIVE: The purpose of this study was to analyze whether peritoneal invasion is an independent risk factor for worse oncologic outcome after curative colon cancer resection.

DESIGN: This was a retrospective analysis with multivariate regression of a prospective database, according to Strengthening the Reporting of Observational Studies in Epidemiology Statement.

SETTINGS: The study was conducted in a specialized colorectal unit of a tertiary hospital.

PATIENTS: A consecutive series of pT3-pT4a-pT4b patients with colon cancer who underwent curative surgery (1993–2010) were included, and patients with metastasis were excluded.

MAIN OUTCOME MEASURES: A multivariate Cox regression analysis was performed to assess independent risk factors for 5-year local recurrence, peritoneal carcinomatosis-like recurrence, disease-free survival, and cancer-specific survival.

RESULTS: A total of 1010 patients were analyzed (79.3% pT3, 9.9% pT4a, and 10.8% pT4b). At diagnosis, 22.0% had obstructive symptoms, and 10.5% had bowel perforation. A total of 72.2% of the surgeries were elective, and in 15.6% en bloc resection of contiguous organs was performed. Median follow-up was 62 months (38–100 mo). For the whole group, 5-year actuarial rates were 8.8% for local recurrence, 2.5% for peritoneal carcinomatosis, 75.5% for disease-free survival, and 81.8% for cancer-specific survival. At multivariate analysis, pT4a stage was an independent risk factor for local recurrence (p = 0.002; HR = 3.1), peritoneal carcinomatosis (p = 0.02; HR = 4.9), worse disease-free survival (p = 0.002; HR = 1.9), and cancer-specific survival (p = 0.001; HR = 2.2). When considering only the 566 patients with ≥12 nodes identified, T stage was still associated with higher local recurrence (p = 0.04) and carcinomatosis rate (p = 0.04), as well as worse disease-free (p = 0.009) and cancer-specific survival (p = 0.014).

LIMITATIONS: This was a retrospective, single-center study.

CONCLUSIONS: pT4a stage is an independent risk factor for worse oncologic outcome after curative colon cancer resection compared with pT3 and pT4b stages. The current pT4a-pT4b classification should be reconsidered. Of note, even in pT4a patients, 5-year carcinomatosis rate does not exceed 6%. See Video Abstract at http://links.lww.com/DCR/A926.

1 Digestive Surgery Unit, Department of General Surgery, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain

2 Department of Haematology and Medical Oncology, Hospital Clinico Universitario, University of Valencia, Valencia, Spain

3 Department of Pathology, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: None reported.

Financial Disclosure: None reported.

Gloria Baguena and Gianluca Pellino contributed equally to this article.

Correspondence: Matteo Frasson, Ph.D., E.B.S.Q-c., M.D., Hospital Universitario y Politecnico La Fe, Avda de Fernando Abril Martorell, n. 106, Piso 5, Torre G 46026 Valencia, Spain. E-mail: dr.frasson.matteo@gmail.com. Twitter: @frasson_matt

© 2019 The American Society of Colon and Rectal Surgeons