A Modified Tumor-Node-Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined

The optimal minimum lymph node count for carcinoembryonic antigen elevated colon cancer: a population-based study in the SEER set and External set

PURPOSE

The aim of this paper was to clarify the optimal minimum number of lymph node for CEA-elevated (≥ 5 ng/ml) colon cancer patients.

METHODS

Thirteen thousand two hundred thirty-nine patients from the SEER database and 238 patients from the Second Affiliated Hospital of Harbin Medical University (External set) were identified. For cancer-specific survival (CSS), Kaplan-Meier curves were drawn and data were analyzed using log-rank test. Using X-tile software, the optimal cut-off lymph node count was calculated by the maximal Chi-square value method. Cox regression model was applied to perform survival analysis.

RESULTS

In CEA-elevated colon cancer, 18 nodes were defined as the optimal minimum node. The number of lymph node examined (< 12, 12-17 and ≥ 18) was an independent prognosticator in both SEER set (HR_{12-17 nodes} = 1.329, P <  0.001; HR_{< 12 nodes} = 1.985, P <  0.001) and External set (HR_{12-17 nodes} = 1.774, P <  0.032; HR_{< 12 nodes} = 2.741, P <  0.006). Moreover, the revised 18-node standard could identify more positive lymph nodes compared with the 12-node standard in this population.

CONCLUSIONS

With the purpose of favorable long-term survival and accurate nodal stage for CEA-elevated colon cancer patients, the 18-node standard could be regarded as an alternative to the 12-node standard advocated by the ASCO and NCCN guidelines.

Comparison of robotic versus laparoscopic right colectomy node retrieval in the obese population

Data are scarce comparing robotic and laparoscopic colectomy node retrieval based on body mass index or age. With differences in anastomosis, mobilization, and ligation between these approaches, obese and/or elderly patients undergoing robotic surgery may have differences in node yield compared to laparoscopy. A retrospective review was conducted between four institutions from February 1, 2019 through August 1, 2021, during which 144 right colectomies were performed. Benign pathology, open colectomies, and conversions to open were excluded. All included surgeons had at least five patients to ensure experience. The population was categorized by a robotic or laparoscopic approach. Records were reviewed focusing on age, body mass index, surgical approach, anastomosis, pathology, and node count. The node count was then compared by body mass index and age between the robotic or laparoscopic approach to identify differences. After applied exclusions and outlier analysis, our final sample consisted of 80 patients. Both body mass index and age were significant, (p = 0.002 and p = 0.005, respectively). Body mass index ≤ 25.0 and age < 60 years old had higher average node counts. These variables interacted, (p = 0.003); those with both < 60 years old and body mass index ≤ 25 showed the greatest number of nodes (36.9). Laparoscopy yielded more nodes in ≥ 60 years old than robotics (27.4 verses 20.9), though this was not significant (p = 0.68). Node retrieval in overweight and obese patients did not differ between approaches (p = 0.48). Both body mass index and age influence the number of nodes that can be extracted in right hemicolectomies by experienced surgeons.

Mesenteric location of lymph node metastasis for colorectal cancer

BACKGROUND

The number of lymph node metastasis (LNM) is a strong prognostic factor in the treatment of colorectal cancer (CRC). However, the impact of the mesentery location on LNM remains unclear. We assessed the impact LNM location on the recurrence of stage III CRC.

METHODS

Subjects with CRC and pathologically positive LNM were enrolled retrospectively. We defined three groups: LNM adjacent to the tumour (group A), metastases with horizontal or vertical spread (group B), and metastases with both horizontal and vertical spread (group C). Recurrence-free survival (RFS) was the primary outcome measure used for the study.

RESULTS

A total of 241 (Group A: 121, B: 90, and C: 30) patients were recruited for the study. Multivariate analysis by Cox regression model indicated LNM location to be an independent predisposing risk factor for recurrence [group B: Hazard ratio (HR) 2.01, 95% Confidential interval (CI) 1.12-3.60, P = 0.019; group C: HR 3.00, 95% CI 1.34-6.72, P = 0.008]. Addition of mesentery spread to the N classification was significant risk factor for recurrence (mN2a: HR 2.01, 95% CI 1.07-3.78, P = 0.029; mN2b: HR 3.96, 95% CI 2.12-7.40, P < 0.01). Comparison of Harrell's C-index values was conducted, and the modified N staging risk was 0.6377, whereas the TNM N stage classification was 0.5869.

CONCLUSION

Mesentery location of LNM was a risk factor and consideration of it might be beneficial for accurate prediction of CRC prognosis.

The relation of blood cell division control protein 42 level with disease risk, comorbidity, tumor features/markers, and prognosis in colorectal cancer patients

BACKGROUND

Cell division control protein 42 (CDC42) is involved in colorectal cancer (CRC) progression by modulating CD8⁺ T cell activation, immune escape, and direct oncogenetic biological processes. This study aimed to explore the correlation of blood CDC42 with disease risk, comorbidities, disease features, tumor markers, and prognosis among CRC patients.

METHODS

CDC42 in peripheral blood mononuclear cells was detected by reverse transcription-quantitative polymerase chain reaction from 250 resectable CRC patients and 50 healthy controls (HCs). CDC42 was divided by quartiles, as well as high and low expressions in CRC patients for correlation and survival analysis.

RESULTS

CDC42 was elevated in CRC patients vs. HCs (p < 0.001), which had a good ability to distinguish CRC patients from HCs with the area under the curve (95% confidence interval) of 0.889 (0.841-0.937). In CRC patients, CDC42 was not associated with demographics or comorbidities (all p > 0.05), while its higher quartile was linked to increased T stage (p < 0.001), N stage (p = 0.009), TNM stage (p < 0.001), abnormal carcinoembryonic antigen (p = 0.043), and adjuvant chemotherapy administration (p = 0.002). Higher CDC42 quartile (p = 0.002) and CDC42 high (vs. low) (p < 0.001) were related to worse disease-free survival (DFS); meanwhile, elevated CDC42 quartile (p = 0.002) and CDC42 high (vs. low) (p = 0.001) were also linked to poor overall survival (OS). Multivariate Cox's regression analysis presented that CDC42 quartile 3 and 4 (vs. quartile 1) independently predicted declined DFS and OS (all p < 0.05).

CONCLUSION

Circulating CDC42 relates to higher disease risk, T, N, and TNM stage, abnormal tumor marker, and poor prognosis among CRC patients.