肿瘤面积可能是一个潜在的预后指标。本研究旨在确定和验证肿瘤面积在可治愈结肠癌中的预后价值。这项回顾性研究包括接受结肠癌根治手术的患者的培训和验证队列。使用Cox比例风险回归模型鉴定了整体生存（OS）和无病生存（DFS）的独立预后因素。使用集成的受试者工作特征曲线下面积（iAUC）评估了预后因素和模型的预后判别能力。与其他个体因素相比较了肿瘤面积和其他因素的预后判别能力，以及TNM分期系统和其他预后模型的预后判别能力。使用双样本Wilcoxon检验发现两个iAUC之间存在显著差异。 P＜0.05被视为统计上显著。在培训队列中纳入了3051例结肠癌患者和872例验证队列患者。在培训队列中，肿瘤面积、年龄、分化程度、T分期和N分期是独立的OS和DFS预后因素。与肿瘤面积相比，T分期、最大肿瘤直径、分化程度、肿瘤位置和检出淋巴结数目在OS和DFS预后判别特征上表现更好。结合T分期、N分期和肿瘤面积的新预后模型（OS的iAUC为0.714，P＜0.001；DFS的iAUC为0.694，P＜0.001）显示出更好的预后判别能力，超过了TNM分期系统（T分期+N分期）的预后判别能力（OS的iAUC为0.664，DFS的iAUC为0.658）。在独立验证队列中观察到类似的结果。肿瘤面积在可治愈结肠癌患者以及淋巴结检出数目充足的情况下被确定为OS和DFS的独立预后因素。结合T分期、N分期和肿瘤面积的新预后模型可能是当前TNM分期系统的替代方法。版权所有© 2023 作者。由Wolters Kluwer Health，Inc.出版。

Tumor area may be a potential prognostic indicator. The present study aimed to determine and validate the prognostic value of tumor area in curable colon cancer.This retrospective study included a training and validation cohorts of patients who underwent radical surgery for colon cancer. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were identified using Cox proportional hazards regression models. The prognostic discrimination was evaluated using the integrated area under the receiver operating characteristic curves (iAUCs) for prognostic factors and models. The prognostic discrimination between tumor area and other individual factors was compared, along with the prognostic discrimination between TNM staging system and other prognostic models. Two-sample Wilcoxon tests were carried out to identify significant differences between the two iAUCs. A two-sided P<0.05 was considered statistically significant.A total of 3,051 colon cancer patients were included in the training cohort and 872 patients in the validation cohort. Tumor area, age, differentiation, T stage, and N stage were independent prognostic factors for both OS and DFS in the training cohort. Tumor area had a better OS and DFS prognostic discrimination characteristics than T stage, maximal tumor diameter, differentiation, tumor location, and number of retrieved lymph nodes. The novel prognostic model of T stage + N stage + tumor area (iAUC for OS, 0.714, P<0.001; iAUC for DFS, 0.694, P<0.001) showed a better prognostic discrimination than the TNM staging system (T stage + N stage; iAUC for OS, 0.664; iAUC for DFS, 0.658). Similar results were observed in an independent validation cohort.Tumor area was identified as an independent prognostic factor for both OS and DFS in curable colon cancer patients, and in cases with adequate number of retrieved lymph nodes. The novel prognostic model of combining T stage, N stage, and tumor area may be an alternative to the current TNM staging system.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.