title: Smaller tumor size is associated with poor survival in T4b colon cancer.
abstract: OBJECTIVE
  To hypothesize that in patients with colon cancer showing heavy intestinal wall invasion without distant metastasis (T4bN0-2M0), small tumor size would correlate with more aggressive tumor behaviors and therefore poorer cancer-specific survival (CSS).
  
  
  METHODS
  We analyzed T4bN0-2M0 colon cancer patients in the Surveillance, Epidemiology and End Results (SEER) database. A preliminary analysis of T4bN0-2M0 colon cancer patients at the Fudan University Shanghai Cancer Center is also presented.
  
  
  RESULTS
  A total of 1734 T4bN0-2M0 colon cancer patients from the SEER database were included. Kaplan-Meier analysis revealed decreasing CSS with decreasing tumor size (P < 0.001). Subgroup analysis showed a significant association between poorer CSS with smaller tumor size in T4bN0 patients (P = 0.024), and a trend of association in T4bN1 (P = 0.182) and T4bN2 patients (P = 0.191). Multivariate analysis identified tumor size as an independent prognostic factor for CSS in T4bN0-2M0 patients (P = 0.024). Preliminary analysis of Fudan University Shanghai Cancer Center samples suggested the 5-year CSS was 50.0%, 72.9% and 77.1% in patients with tumors ≤ 4.0 cm, 4.0-7.0 cm and ≥ 7.0 cm.
  
  
  CONCLUSIONS
  Smaller tumor size is associated with poorer CSS in the T4bN0-2M0 subset of colon cancer, particularly in the T4bN0M0 subgroup.
authors.affiliation: Ben Huang, Yang Feng, Shao-Bo Mo, San-Jun Cai, Li-Yong Huang, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 20032, China.
authors.forename: Ben
authors.initials: B
authors.lastname: Huang
authors.affiliation: Ben Huang, Yang Feng, Shao-Bo Mo, San-Jun Cai, Li-Yong Huang, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 20032, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Ben Huang, Yang Feng, Shao-Bo Mo, San-Jun Cai, Li-Yong Huang, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 20032, China.
authors.forename: Shao-Bo
authors.initials: SB
authors.lastname: Mo
authors.affiliation: Ben Huang, Yang Feng, Shao-Bo Mo, San-Jun Cai, Li-Yong Huang, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 20032, China.
authors.forename: San-Jun
authors.initials: SJ
authors.lastname: Cai
authors.affiliation: Ben Huang, Yang Feng, Shao-Bo Mo, San-Jun Cai, Li-Yong Huang, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 20032, China.
authors.forename: Li-Yong
authors.initials: LY
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program
keywords: Colon cancer; Locally advanced colon cancer; Survival; T4b colon cancer; Tumor size