Advanced T stage and nodal disease are independently associated with worse cancer-specific survival in stage IV colorectal cancer: A SEER-based survival analysis.
[BACKGROUND] Stage IV colorectal cancer (CRC) is associated with poor 5-year survival <15 %.
- p-value p = 0.017
- p-value p < 0.001
- 95% CI 20.4-21
- HR 1.33
APA
Emile SH, Horesh N, et al. (2026). Advanced T stage and nodal disease are independently associated with worse cancer-specific survival in stage IV colorectal cancer: A SEER-based survival analysis.. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 52(2), 111315. https://doi.org/10.1016/j.ejso.2025.111315
MLA
Emile SH, et al.. "Advanced T stage and nodal disease are independently associated with worse cancer-specific survival in stage IV colorectal cancer: A SEER-based survival analysis.." European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, vol. 52, no. 2, 2026, pp. 111315.
PMID
41418575
Abstract
[BACKGROUND] Stage IV colorectal cancer (CRC) is associated with poor 5-year survival <15 %. We aimed to investigate the association between T and N stages of stage IV CRC and survival.
[METHODS] A retrospective population-based cohort analysis of patients who underwent surgery for stage IV colorectal adenocarcinomas from the SEER database (2010-2020) was conducted. T and N stages of the primary CRC were examined as independent predictors for cancer-specific survival (CSS) against other factors in a multivariable Cox regression analysis. the main outcome measure was 5-year CSS. Kaplan-Meier statistics were used to show differences in CSS among the groups.
[RESULTS] 73,427 patients (52.4 % male; mean age: 64.9 years) were included. 5-year CSS was 20.7 % (95 %CI:20.4-21 %). 5-year CSS rate significantly decreased with increased T stage (T1 and T2 = 33.3 %, T3 = 22.1 %, T4 = 17.4) and with nodal disease (N0 = 31.2 %, N1 = 23.6 %, N2 = 14.5 %). T4 tumors (HR:1.33, 95 %CI:1.05, 1.68; p = 0.017) and N1 and N2 disease (HR:1.27 and 1.59, respectively; p < 0.001) were independently associated with reduced CSS. Other independent predictors were increased age (HR:1.02; p < 0.001), male sex (HR:1.07; p = 0.005), Black race (HR:1.19; p < 0.001), signet-ring cell histology (HR:1.44; p < 0.001), poorly differentiated (HR:1.58; p < 0.001) and undifferentiated (HR:1.76; p < 0.001) carcinomas, perineural invasion (HR:1.23; p < 0.001), tumor deposits (HR:1.03; p < 0.001), elevated CEA levels (HR:1.96; p < 0.001), and multiple organ metastases (HR:1.82; p < 0.001). CSS improved with distant metastases resection (HR:0.86; p < 0.001) and systemic therapy (neoadjuvant: HR = 0.51, adjuvant: HR = 0.48, combined: HR = 0.40; p < 0.001).
[CONCLUSIONS] Advanced T and N stages of stage IV CRC were associated with worse CSS. Older, male, and Black patients with high-grade, mucinous, and signet-ring cell carcinomas, perineural invasion, tumor deposits, and elevated CEA levels had worse CSS. Systemic treatments conferred >50 % increase in CSS in stage IV disease.
[METHODS] A retrospective population-based cohort analysis of patients who underwent surgery for stage IV colorectal adenocarcinomas from the SEER database (2010-2020) was conducted. T and N stages of the primary CRC were examined as independent predictors for cancer-specific survival (CSS) against other factors in a multivariable Cox regression analysis. the main outcome measure was 5-year CSS. Kaplan-Meier statistics were used to show differences in CSS among the groups.
[RESULTS] 73,427 patients (52.4 % male; mean age: 64.9 years) were included. 5-year CSS was 20.7 % (95 %CI:20.4-21 %). 5-year CSS rate significantly decreased with increased T stage (T1 and T2 = 33.3 %, T3 = 22.1 %, T4 = 17.4) and with nodal disease (N0 = 31.2 %, N1 = 23.6 %, N2 = 14.5 %). T4 tumors (HR:1.33, 95 %CI:1.05, 1.68; p = 0.017) and N1 and N2 disease (HR:1.27 and 1.59, respectively; p < 0.001) were independently associated with reduced CSS. Other independent predictors were increased age (HR:1.02; p < 0.001), male sex (HR:1.07; p = 0.005), Black race (HR:1.19; p < 0.001), signet-ring cell histology (HR:1.44; p < 0.001), poorly differentiated (HR:1.58; p < 0.001) and undifferentiated (HR:1.76; p < 0.001) carcinomas, perineural invasion (HR:1.23; p < 0.001), tumor deposits (HR:1.03; p < 0.001), elevated CEA levels (HR:1.96; p < 0.001), and multiple organ metastases (HR:1.82; p < 0.001). CSS improved with distant metastases resection (HR:0.86; p < 0.001) and systemic therapy (neoadjuvant: HR = 0.51, adjuvant: HR = 0.48, combined: HR = 0.40; p < 0.001).
[CONCLUSIONS] Advanced T and N stages of stage IV CRC were associated with worse CSS. Older, male, and Black patients with high-grade, mucinous, and signet-ring cell carcinomas, perineural invasion, tumor deposits, and elevated CEA levels had worse CSS. Systemic treatments conferred >50 % increase in CSS in stage IV disease.
MeSH Terms
Humans; Male; Female; Middle Aged; Neoplasm Staging; Colorectal Neoplasms; SEER Program; Retrospective Studies; Aged; Adenocarcinoma; Survival Rate; Lymphatic Metastasis; United States
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