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Cancers 2018, 10(8), 263; https://doi.org/10.3390/cancers10080263

Real-World Implications of Nonbiological Factors with Staging, Prognosis and Clinical Management in Colon Cancer

1,2
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1,2
,
1,2
,
1,2,* and 1,2,*
1
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
2
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
*
Authors to whom correspondence should be addressed.
Received: 3 July 2018 / Revised: 5 August 2018 / Accepted: 6 August 2018 / Published: 8 August 2018
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Abstract

Background: The present study analyzed the nonbiological factors (NBFs) together with the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) staging system to generate a refined, risk-adapted stage for the clinical treatment of colon cancer. Methods: Eligible patients (N = 28,818) with colon cancer between 1 January 2010 and 31 December 2014, were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier curves and Cox proportional hazards regression, analyzed the probabilities of cancer-specific survival (CSS) in patients with colon cancer, with different NBF-TNM stages. Results: Insurance status, marital status, and median household income were significant prognostic NBFs in the current study (p < 0.05). The concordance index of NBF-TNM stage was 0.857 (95% confidence interval (CI) = 0.8472–0.8668). Multivariate Cox analyses, indicated that NBF1-stage was independently associated with a 50.4% increased risk of cancer-specific mortality in colon cancer (p < 0.001), which increased to 77.1% in non-metastatic colon cancer. NBF0-stage improved in CSS as compared to the NBF1-stage in the respective stages (p < 0.05). Conclusions: The new proposed NBF-stage was an independent prognostic factor in colon cancer. Effect of NBFs on the survival of colon cancer necessitates further clinical attention. Moreover, the incorporation of NBF-stage into the AJCC TNM staging system is essential for prognostic prediction, and clinical guidance of adjuvant chemotherapy in stage II and III colon cancer. View Full-Text
Keywords: non-biological factors; AJCC TNM staging system; prognostication; colon cancer; SEER non-biological factors; AJCC TNM staging system; prognostication; colon cancer; SEER
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Liu, Q.; Luo, D.; Cai, S.; Li, Q.; Li, X. Real-World Implications of Nonbiological Factors with Staging, Prognosis and Clinical Management in Colon Cancer. Cancers 2018, 10, 263.

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