Past

Jass et al.1 initially described tumor border configuration (TBC, either infiltrating or pushing) while analyzing resected rectal tumors. Since then, TBC has been considered a poor prognostic factor in colorectal cancer.2,3,–4 However, studies group colon and rectal cancers together in their analyses. This study aimed to assess the prognostic value of TBC in stages 2 and 3 colon cancer.

Present

This study investigated 700 patients from the authors’ institution with surgically resected stage 2 or 3 colon cancer.5 Infiltrating TBC was associated with stage 3 tumors, extramural vascular invasion, likelihood of progression to metastasis, and lower overall and disease-free survival rates (p < 0.05). Infiltrating TBC also was an independent prognostic factor in Cox regression analysis for overall survival (adjusted hazard ratio [aHR] 1.8; 95% confidence interval [CI], 1.4–2.4; p < 0.001) and disease-free survival (aHR 1.7; 95% CI 1.3–2.2; p < 0.001). Pairwise comparisons showed no difference in overall or disease-free survival between the patients with stage 2 disease and infiltrating TBC and the patients with stage 3 disease and pushing TBC (aHR 1.1; 95% CI 0.7–1.7; p = 0.8) and (aHR 1.0; 95% CI 0.7–1.6; p = 0.9), respectively.

Future

This study showed that infiltrating TBC is a poor prognostic factor in colon cancer. The authors believe the study results could challenge the approach to stages 2 and 3 colon tumors. Future studies should assess the benefit of adjuvant chemotherapy for patients with high-risk features (e.g., TBC) in stage 2 disease and potentially identify patients with stage 3 disease who might not require adjuvant chemotherapy.