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Updated: Jun 18, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
T4bN0 colon cancer shows worse survival than T1-2N1 disease: a multicenter real-world study in China
Xin Li1, Lei Liang1, Zhen-Ya Yang1
1Department of Surgical Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Background:
Growing evidence suggests that deeply invasive node-negative colon cancer, particularly T4bN0 disease, may have a worse prognosis than early node-positive tumors, challenging the current American Joint Committee on Cancer (AJCC) 8th edition staging system. This study aimed to compare clinicopathological features and survival outcomes between T4N0 and T1-2N1 colon cancer in a multicenter cohort.
Methods:
We conducted a multicenter retrospective cohort study of 391 patients with stage IIB (T4aN0), IIC (T4bN0), or IIIA (T1-2N1) colon cancer treated with curative-intent surgery between 2014 and 2024 at three centers in China. Rectal cancer cases were excluded to reduce treatment heterogeneity. Clinicopathological characteristics were compared across groups, and progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression methods.
Results:
Among the 391 patients, 254 had stage IIB, 56 had stage IIC, and 81 had stage IIIA disease. Compared with stage IIIA, T4N0 tumors showed a less favorable pathological profile, including poorer differentiation, more frequent perineural invasion, and more frequent carcinoembryonic antigen (CEA) elevation. In pairwise analyses, stage IIC (T4bN0) was associated with significantly worse PFS (log-rank P=0.008) and OS (log-rank P=0.02) than stage IIIA, whereas no statistically significant differences were observed between stage IIB and stage IIIA. When T4N0 tumors were regrouped and compared with T1-2N1 disease, T4N0 was associated with worse OS (log-rank P=0.04), whereas the PFS difference did not reach statistical significance (log-rank P=0.11). CEA-stratified analyses suggested a more unfavorable survival pattern in the elevated-CEA subgroup, although formal interaction testing was not statistically significant.
Conclusions:
In colon cancer, the adverse prognostic signal within T4N0 disease appears to be driven primarily by T4bN0. These findings support reconsideration of current staging paradigms, particularly for T4bN0 colon cancer, and warrant further prospective validation of risk-adapted postoperative strategies.
