Prognostic Significance of Multiple High-Risk Features in Stage II Colon Adenocarcinomas Compared With Stage III Disease

Abstract

Introduction

The prognostic significance of high-risk features (HRFs) in stage II colon cancer is established, but the cumulative impact of multiple HRFs and their relation to stage III disease remain unclear. This study evaluated whether patients with stage II colon adenocarcinomas with ≥3 HRFs demonstrate survival outcomes comparable to stage III disease.

Methods

A retrospective analysis included 377 patients who underwent curative resection for colon adenocarcinoma between 2016 and 2022. Patients were classified as stage II <3 HRFs (n = 102), stage II ≥3 HRFs (n = 88), and stage III (n = 187). Clinicopathologic variables were compared, and overall (OS) and disease-free survival (DFS) were analyzed.

Results

Patients with stage II ≥3 HRFs demonstrated 5-year OS and DFS rates of 58.9% and 57.8%, significantly worse than stage II <3 HRFs (79.4% and 74.5%) and comparable to stage III (71.2% and 61.3%) (P = .037, P = .040). Subgroup analysis confirmed that stage II ≥3 HRFs had worse OS and DFS than <3 HRFs (P = .010, P = .017), but outcomes were comparable to stage III (P = .126, P = .600). On multivariate analysis, predictors of worse OS included age ≥65, stoma formation, <12 lymph nodes, and elevated CEA, while DFS was adversely influenced by age ≥65, stoma formation, tumor volume >30 cm³, <12 lymph nodes, elevated CEA, and stage III disease.

Conclusion

Stage II colon cancers with ≥3 HRFs demonstrate survival outcomes comparable to stage III, emphasizing the cumulative prognostic impact of multiple risk factors. These findings reinforce adjuvant chemotherapy consideration and highlight the need for refined risk stratification.