A Seer-Based Analysis of Survival Predictors in Stage I Colorectal Adenocarcinomas.

Background: We assessed predictors of overall (OS) and cancer-specific survival (CSS) in stage I colorectal cancer (CRC).

Methods: Retrospective analysis of patients with stage I colon or rectal adenocarcinomas from the SEER database (2010-2020) Survival was assessed using Kaplan-Meier statistics and multivariable Cox regression analyses. The primary outcomes were 5-year OS and CSS.

Results: 40,001 patients (51.3% male; mean age: 65.1 ± 12.6 years) were included. Colon and rectal cancers accounted for 75.8% and 24.2%, respectively. Five-year OS and CSS were 83.1% (95% CI: 82.6-83.5%) and 93.2% (95% CI: 92.9-93.5%), respectively. Factors independently associated with worse OS were age (HR: 1.07; p < 0.001), male sex (HR:1.48; p < 0.001), Black race (HR: 1.25; p < 0.001), single, divorced, or widowed status (HR: 1.49, 1.46, and 1.43; p < 0.001), tumor size (HR: 1.001; p = 0.008), poorly differentiated carcinomas (HR: 1.32; p < 0.001), undifferentiated carcinomas (HR:1.44; p = 0.026), perineural invasion (HR: 1.84; p < 0.001), elevated CEA levels (HR: 1.68; p < 0.001), and systemic therapy (neoadjuvant: HR: 1.3; p = 0.032, adjuvant: HR: 2.2; p < 0.001, both: HR: 1.97; p < 0.001). Factors independently associated with worse CSS were age (HR: 1.05; p < 0.001), male sex (HR: 1.32; p < 0.001), Black race (HR: 1.43; p < 0.001), marital status (HR: 1.44, 1.28, and 1.68; p < 0.001), tumor size (HR: 1.003; p < 0.001), poorly differentiated carcinomas (HR: 1.77; p < 0.001), perineural invasion (HR: 2.29; p < 0.001), elevated CEA levels (HR: 2.24; p < 0.001), and systemic therapy (neoadjuvant: HR: 2.53; p = 0.032, adjuvant: HR: 4.22; p < 0.001, both: HR: 3.83; p < 0.001).

Conclusions: Although patients with stage I CRC had excellent survival, single, older, Black, male patients with large, high-grade tumors associated with perineural invasion and elevated CEA levels had a higher mortality risk.