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Liu Q, Huang M, Yang J, Jiang M, Zhao Z, Zhao H, He T, Bai Y, Zhang R, Zhang M. Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis. BMJ Open 2023; 13:e072244. [PMID: 38135324 DOI: 10.1136/bmjopen-2023-072244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Clinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer. DESIGN Systematic review and meta-analysis of primary studies. DATA SOURCES PubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included. DATA EXTRACTION AND SYNTHESIS OR with 95% conference intervals was extracted and pooled. RESULTS A total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph-vascular invasion were not significantly associated with the lymph node yield. CONCLUSIONS The study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.
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Affiliation(s)
- Qianqian Liu
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Min Huang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jing Yang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Mengyuan Jiang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Ziru Zhao
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Haitong Zhao
- Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Tingting He
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuping Bai
- The Department of Pathology, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Rui Zhang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Min Zhang
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
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Yang C, Cao F, Huang S, Zheng Y. Follistatin-Like 3 Correlates With Lymph Node Metastasis and Serves as a Biomarker of Extracellular Matrix Remodeling in Colorectal Cancer. Front Immunol 2021; 12:717505. [PMID: 34335633 PMCID: PMC8322704 DOI: 10.3389/fimmu.2021.717505] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background As a heterogeneous disease, colorectal cancer (CRC) presents a great challenge to individualized treatment due to its lymph node metastasis (LNM). Existing studies have shown that immune and stromal components in extracellular matrix (ECM) act as important part in tumorigenicity and progression, while their roles in LNM have not been fully elucidated. Here, crucial ECM-related genes responsible for LNM in CRC were selected by multi-omics analysis. Methods Firstly, we characterized the immune infiltration landscape of CRC samples from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) databases by using ssGSEA algorithm. The CRC patients were divided into several immune subgroups by hierarchical clustering analyses. Then, differential genes were identified among immune subgroups and CRC vs. normal tissues in TCGA and GEO GSE39582 cohorts, respectively. Next, weighted correlation network analysis (WGCNA) was employed to construct a co-expression network to find LNM-related modules and hub genes. Subsequently, we evaluated the clinical value of hub gene in prognostic prediction and chemotherapy/immunotherapy. Besides, the protein level of key gene was verified in an external cohort from our center. Finally, we explored the underlying mechanism of FSTL3-mediated LNM by Gene function annotation and correlation analysis. Results Two immune subgroups, namely Immunity_High and Immunity_Low, were defined among the two CRC cohorts using ssGSEA algorithm, respectively. Based on the two immune subgroups, 2,635 overlapping differentially expressed genes were obtained from two cohorts, which were sequentially subjected to WGCNA and univariate Cox regression analysis. Ultimately, FSTL3 was selected as the key gene. Here, we first confirmed that overexpression of FSTL3 correlated with LNM and worse prognosis in CRC and was verified at the protein level in the external validation cohort. Moreover, FSTL3 expression showed strongly positive correlation with immune and stromal components in ECM. We furthermore found that FSTL3 may accelerate LNM through the formation of inhibitory immune microenvironment via promoting macrophage and fibroblast polarization and T cell exhaustion. Interestingly, high FSTL3 expression is linked to chemoresistance, but immunotherapy-sensitive. Conclusion FSTL3 is identified as a biomarker for ECM remodeling and worse clinical outcomes for the first time in CRC and is also a potential immunotherapeutic target to block LNM for CRC.
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Affiliation(s)
- Chao Yang
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fengyu Cao
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuoyang Huang
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yongbin Zheng
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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