Fırat Akagunduz, Ali Kaan Güren, Erkam Kocaaslan, Burak Paçacı, Mustafa Alperen Tunç, Ahmet Demirel, Yesim Ağyol, Pınar Erel, Abdussamet Çelebi, Selver Işik, Ezgi Coban, Murat Sarı, Ibrahim Vedat Bayoğlu, Osman Köstek, Nazım Can Demircan
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Abstract
Background: The prognostic significance of pathological T stage relative to nodal involvement in colon cancer remains controversial. Emerging evidence suggests that patients with T4N0 disease may experience outcomes comparable to or worse than those with node-positive disease.
Objectives: This study aimed to compare long-term oncologic outcomes between patients with non-metastatic T4N0 colon cancer and those with T2-3N1 disease.
Design: Retrospective.
Settings: Single-center.
Patients and methods: Retrospective analysis of patients with histologically confirmed, non-metastatic colon adenocarcinoma who underwent curative-intent surgery between 1999 and 2020. Patients were categorized into T4N0 and T2-3N1 groups.
Main outcome measures: Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and compared with log-rank tests. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models.
Sample size: A total of 273 patients were included, of whom 78 (28.6%) were staged as T4N0 and 195 (71.4%) as T2-3N1.
Results: After a median follow-up of 72 months, patients with T4N0 disease showed significantly worse OS than those with T2-3N1 disease (HR=1.72, 95% CI 1.06-2.75; P=.02). Five-year OS rates were 66.6% and 79.8% in the T4N0 and T2-3N1 groups, respectively. On multivariate analysis, pathological T4N0 stage (HR=1.74, 95% CI 1.03-2.93; P=.03), age ≥65 years, vascular invasion, and omission of oxaliplatin-based adjuvant chemotherapy independently predicted poorer OS. Stage T4N0 was also associated with higher locoregional and distant recurrence rates, with increased peritoneal involvement.
Conclusions: Non-metastatic T4N0 colon cancer is associated with less favorable long-term survival and higher recurrence rates compared with T2-3N1 disease, supporting its classification as a biologically aggressive subgroup that may benefit from treatment strategies similar to selected stage III colon cancers.
Limitations: The retrospective, single-center design may introduce selection bias, and limited molecular data precluded detailed sub-group analyses.
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