Reduced recurrence rates with partial resection for stage III T1-2 colon cancer compared to hemicolectomy resection: a SEER database analysis

Abstract

Abstract Purpose The aim of our study was to compare the oncological survival outcomes between partial colectomy (PC) and hemicolectomy (HC) in patients diagnosed with stage III T1-2 colon cancer. Methods A total of 4,248 patients diagnosed with stage III T1-2 colon cancer, who underwent either hemicolectomy (n = 2,348) or partial colectomy (n = 1,900) between 2010 and 2019, were included in the Surveillance, Epidemiology, and End Results (SEER) database. We conducted a comparative analysis of overall survival (OS) and cancer-specific survival (CSS) between these two surgical groups. Additionally, we sought to determine the optimal thresholds for the number of harvested lymph nodes and tumor size. Predictive nomograms for patients with Stage III T1-2 colon cancer were constructed using independent risk factors identified CSS. Results The results revealed significant differences between the PC and HC groups in terms of age, gender, race, tumor site, histopathology, stage, pT, pN, scope of regional lymph nodes, postoperative chemotherapy, postoperative radiation, harvested lymph nodes, CEA pretreatment, marital status, and tumor size (all with P < 0.05). It was observed that hemicolectomy patients had slightly lower OS and CSS rates than patients who underwent partial colectomy (all with P < 0.001). Following propensity score matching (PSM), the OS and CSS rates in the two groups remained significantly different (P < 0.05). The survminer R package was employed to determine the optimal thresholds for harvested lymph node and tumor size counts in stage III T1-2 colon cancer patients, which were found to be 10 and 4.7 cm, respectively. Notably, CSS did not significantly differ between patients with ≥ 10 lymph nodes harvested and those with ≥ 12 lymph nodes harvested (P = 0.72). Univariate and multivariate Cox regression analyses, as well as survival analyses of stage III T1-2 colon cancer patients, demonstrated that patients receiving partial colectomy experienced a superior survival benefit compared to those undergoing hemicolectomy. Conclusions In the treatment of stage III T1-2 colon cancer patients, partial colectomy demonstrates significant oncological advantages over hemicolectomy. Harvested a minimum of 10 lymph nodes is more effective than the conventional threshold of 12 lymph nodes in distinguishing between patients with a favorable and unfavorable prognosis.