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Naidu K, Chapuis PH, Connell L, Chan C, Rickard MJFX, Ng KS. Lymph node ratio prognosticates overall survival in patients with stage IV colorectal cancer. Tech Coloproctol 2024; 28:115. [PMID: 39177674 PMCID: PMC11343919 DOI: 10.1007/s10151-024-02984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/13/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Lymph node ratio (LNR) is suggested to address the shortcomings of using only lymph node yield (LNY) or status in colorectal cancer (CRC) prognosis. This study explores how LNR affects survival in patients with metastatic colorectal cancer (mCRC), seeking to provide clearer insights into its application. METHODS This observational cohort study investigated stage IV patients with CRC (1995-2021) who underwent an upfront resection of their primary tumour at Concord Hospital, Sydney. Clinicopathological data were extracted from a prospective database, and LNR was calculated both continuously and dichotomously (LNR of 0 and LNR > 0). The primary endpoint was overall survival (OS). The associations between LNR and various clinicopathological variables were tested using regression analyses. Kaplan-Meier and Cox regression analyses estimated OS in univariate and multivariate survival models. RESULTS A total of 464 patients who underwent a primary CRC resection with clear margins (mean age 68.1 years [SD 13.4]; 58.0% M; colon cancer [n = 339,73.1%]) had AJCC stage IV disease. The median LNR was 0.18 (IQR 0.05-0.42) for colon cancer (CC) resections and 0.21 (IQR 0.09-0.47) for rectal cancer (RC) resections. A total of 84 patients had an LNR = 0 (CC = 66 patients; RC = 18 patients). The 5-year OS for the CC cohort was 10.5% (95% CI 8.7-12.3) and 11.5% (95% CI 8.4-14.6) for RC. Increasing LNR demonstrated a decline in OS in both CC (P < 0.001) and RC (P < 0.001). In patients with non-lymphatic dissemination only (LNR = 0 or N0 status), there was better survival compared with those with lymphatic spread (CC aHR1.50 [1.08-2.07;P = 0.02], RC aHR 2.21 [1.16-4.24;P = 0.02]). CONCLUSIONS LNR is worthy of consideration in patients with mCRC. An LNR of 0 indicates patients have a better prognosis, underscoring the need for adequate lymphadenectomy to facilitate precise mCRC staging.
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Affiliation(s)
- K Naidu
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - P H Chapuis
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - L Connell
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
| | - C Chan
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Anatomical Pathology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - M J F X Rickard
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - K-S Ng
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia.
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia.
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia.
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Yokoyama S, Watanabe T, Matsumura S, Tamiya M, Nagano S, Hori Y. Cancer histology in metastatic lymph node predicts prognosis in patients with node-positive stage IV colorectal cancer. PeerJ 2024; 12:e17702. [PMID: 39006028 PMCID: PMC11243965 DOI: 10.7717/peerj.17702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Background Appropriate prognostic indicators are required for patients with stage IV colorectal cancer (CRC). Lymph node metastasis mainly involves four histological types of CRC. Some metastatic lymph nodes (mLNs) showing cribriform carcinoma are associated with distant metastasis in patients with node-positive CRC and are correlated with recurrence and survival in stage III disease. However, the significance of mLN histology in the prognosis of patients with node-positive stage IV disease remains unclear. Methods We enrolled 449 consecutive patients with CRC who underwent primary tumor resection with lymph node dissection between January 2011 and November 2018. This study included 88 patients with node-positive stage IV CRC and synchronous or metachronous distant metastases. We retrospectively investigated the association between cancer histology in the mLNs based on our classification and cancer-specific survival (CSS) in patients with node-positive stage IV CRC. Results Kaplan-Meier analysis showed that CSS was better in patients with CRC and all the mLNs showing tubular-type carcinoma. In contrast, patients with at least some mLNs showing poorly differentiated-type carcinoma had poor prognosis. Multivariate analysis showed that "all mLNs showing tubular-type carcinoma" was an independent good prognostic factor for CSS in patients with node-positive stage IV CRC. In addition, "at least some mLNs showing poorly differentiated-type carcinoma" was an independent poor prognostic factor for CSS in patients with node-positive stage IV disease. Conclusions The histological type of the mLN may indicate a better or poor prognosis for patients with stage IV CRC.
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Affiliation(s)
- Shozo Yokoyama
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan
| | - Takashi Watanabe
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan
| | - Shuichi Matsumura
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan
| | - Masato Tamiya
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan
| | - Shotaro Nagano
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan
| | - Yuya Hori
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan
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Ding Y, Han X, Zhao S, Wang S, Guo J, Leng C, Li X, Wang K, Qiu W, Qi W. Constructing a prognostic model for colorectal cancer with synchronous liver metastases after preoperative chemotherapy: a study based on SEER and an external validation cohort. Clin Transl Oncol 2024:10.1007/s12094-024-03513-5. [PMID: 38834909 DOI: 10.1007/s12094-024-03513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND The combination of preoperative chemotherapy and surgical treatment has been shown to significantly enhance the prognosis of colorectal cancer with liver metastases (CRLM) patients. Nevertheless, as a result of variations in clinicopathological parameters, the prognosis of this particular group of patients differs considerably. This study aimed to develop and evaluate Cox proportional risk regression model and competing risk regression model using two patient cohorts. The goal was to provide a more precise and personalized prognostic evaluation system. METHODS We collected information on individuals who had a pathological diagnosis of colorectal cancer between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) Database. We obtained data from patients who underwent pathological diagnosis of colorectal cancer and got comprehensive therapy at the hospital between January 1, 2010, and June 1, 2022. The SEER data collected after screening according to the inclusion and exclusion criteria were separated into two cohorts: a training cohort (training cohort) and an internal validation cohort (internal validation cohort), using a random 1:1 split. Subgroup Kaplan-Meier (K-M) survival analyses were conducted on each of the three groups. The data that received following screening from the hospital were designated as the external validation cohort. The subsequent variables were chosen for additional examination: age, gender, marital status, race, tumor site, pretreatment carcinoembryonic antigen level, tumor size, T stage, N stage, pathological grade, number of tumor deposits, perineural invasion, number of regional lymph nodes examined, and number of positive regional lymph nodes. The primary endpoint was median overall survival (mOS). In the training cohort, we conducted univariate Cox regression analysis and utilized a stepwise regression approach, employing the Akaike information criterion (AIC) to select variables and create Cox proportional risk regression models. We evaluated the accuracy of the model using calibration curve, receiver operating characteristic curve (ROC), and area under curve (AUC). The effectiveness of the models was assessed using decision curve analysis (DCA). To evaluate the non-cancer-related outcomes, we analyzed variables that had significant impacts using subgroup cumulative incidence function (CIF) and Gray's test. These analyses were used to create competing risk regression models. Nomograms of the two models were constructed separately and prognostic predictions were made for the same patients in SEER database. RESULTS This study comprised a total of 735 individuals. The mOS of the training cohort, internal validation cohort, and QDU cohort was 55.00 months (95%CI 46.97-63.03), 48.00 months (95%CI 40.65-55.35), and 68.00 months (95%CI 54.91-81.08), respectively. The multivariate Cox regression analysis revealed that age, N stage, presence of perineural infiltration, number of tumor deposits and number of positive regional lymph nodes were identified as independent prognostic risk variables (p < 0.05). In comparison to the conventional TNM staging model, the Cox proportional risk regression model exhibited a higher C-index. After controlling for competing risk events, age, N stage, presence of perineural infiltration, number of tumor deposits, number of regional lymph nodes examined, and number of positive regional lymph nodes were independent predictors of the risk of cancer-specific mortality (p < 0.05). CONCLUSION We have developed a prognostic model to predict the survival of patients with synchronous CRLM who undergo preoperative chemotherapy and surgery. This model has been tested internally and externally, confirming its accuracy and reliability.
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Affiliation(s)
- Yixin Ding
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Medical Oncology, Department of Cancer Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxi Han
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shufen Zhao
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shasha Wang
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Guo
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chuanyu Leng
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiangxue Li
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kongjia Wang
- Department of Urology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wensheng Qiu
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Weiwei Qi
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Zou M, Yang ZQ, Gao F. Letter to the editor "Extramural venous invasion (EMVI) in colorectal cancer is associated with increased cancer recurrence and cancer-related death". Eur J Surg Oncol 2023; 49:298-299. [PMID: 36038430 DOI: 10.1016/j.ejso.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Min Zou
- Department of Colorectal and Anal Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu Province, China
| | - Zeng-Qiang Yang
- Department of Colorectal Surgery, Gansu Provincial Central Hospital, Lanzhou, 730070, Gansu Province, China
| | - Feng Gao
- Department of Colorectal and Anal Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu Province, China.
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Skalicky P, Urban O, Ehrmann J, Svebisova H, Klos D, Tesarikova J, Neoral C, Knapkova K, Lovecek M. The short- and long-term outcomes of pancreaticoduodenectomy for distal cholangiocarcinoma. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:386-392. [PMID: 34467956 DOI: 10.5507/bp.2021.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of the study was to calculate the short-term and long-term outcomes of curative-intent surgery in distal cholangiocarcinoma (DCC) patients to identify potential prognostic factors. PATIENTS AND METHODS A retrospective cohort study of 32 consecutive DCC patients treated with pancreaticoduodenectomy between 2009-2017. The clinicopathological and histopathological data were evaluated for prognostic factors using the univariable Cox regression analysis. The Overall Survival (OS) was estimated using the Kaplan-Meier analysis. RESULTS The study comprised a total of 32 patients, with a mean age of 65.8 (± 9.0) years at the time of surgery. R0 resection was achieved in 25 (86.2%) patients, 19 (65.5%) patients received adjuvant oncological therapy. The OS rates at 1, 3 and 5 years were 62.5%, 37.5% and 21.9%, respectively. The 90-day mortality was 3/32 (9.4%) accounting for one-fourth of the first-year mortality rate. The median OS was 28.5 months. The only statistically significant prognostic factor was vascular resection, which was associated with worse OS in the univariable analysis (HR: 3.644; 95%-CI: 1.179-11.216, P=0.025). An age less than 65 years, ASA grade I/II, hospital stay of fewer than 15 days, R0 resection, lymph node ratio less than 0.2 and adjuvant oncological therapy tended to be associated with better OS but without statistically significant relevance. CONCLUSION The main factor directly influencing the survival of DCC patients is surgical complications. Surgical mortality comprises a significant group of patients, who die in the first year following pancreaticoduodenectomy. Vascular resection is the most important negative prognostic factor for long-term survival.
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Affiliation(s)
- Pavel Skalicky
- Department of Surgery I, University Hospital Olomouc, Czech Republic
| | - Ondrej Urban
- Department of Internal Medicine II - Gastroenterology and Geriatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jiri Ehrmann
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Hana Svebisova
- Department of Oncology, University Hospital Olomouc, Czech Republic
| | - Dusan Klos
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jana Tesarikova
- Department of Surgery I, University Hospital Olomouc, Czech Republic
| | - Cestmir Neoral
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Katerina Knapkova
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Martin Lovecek
- Department of Surgery I, University Hospital Olomouc, Czech Republic
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Current Perspectives on the Importance of Pathological Features in Prognostication and Guidance of Adjuvant Chemotherapy in Colon Cancer. Curr Oncol 2022; 29:1370-1389. [PMID: 35323316 PMCID: PMC8947287 DOI: 10.3390/curroncol29030116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022] Open
Abstract
There is not a clear consensus on which pathological features and biomarkers are important in guiding prognosis and adjuvant therapy in colon cancer. The Pathology in Colon Cancer, Prognosis and Uptake of Adjuvant Therapy (PiCC UP) Australia and New Zealand questionnaire was distributed to colorectal surgeons, medical oncologists and pathologists after institutional board approval. The aim of this study was to understand current specialist attitudes towards pathological features in the prognostication of colon cancer and adjuvant therapy in stage II disease. A 5-scale Likert score was used to assess attitudes towards 23 pathological features for prognosis and 18 features for adjuvant therapy. Data were analysed using a rating scale and graded response model in item response theory (IRT) on STATA (Stata MP, version 15; StataCorp LP). One hundred and sixty-four specialists (45 oncologists, 86 surgeons and 33 pathologists) participated. Based on IRT modelling, the most important pathological features for prognosis in colon cancer were distant metastases, lymph node metastases and liver metastases. Other features seen as important were tumour rupture, involved margin, radial margin, CRM, lymphovascular invasion and grade of differentiation. Size of tumour, location, lymph node ratio and EGFR status were considered less important. The most important features in decision making for adjuvant therapy in stage II colon cancer were tumour rupture, lymphovascular invasion and microsatellite instability. BRAF status, size of tumour, location, tumour budding and tumour infiltrating lymphocytes were factored as lesser importance. Biomarkers such as CDX2, EGFR, KRAS and BRAF status present areas for further research to improve precision oncology. This study provides the most current status on the importance of pathological features in prognostication and recommendations for adjuvant therapy in Australia and New Zealand. Results of this nationwide study may be useful to help in guiding prognosis and adjuvant treatment in colon cancer.
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Alexandrescu ST, Selaru FM, Diaconescu AS, Zlate CA, Blanita D, Grigorie RT, Zarnescu NO, Herlea V, Popescu I. Prognostic Value of Lymph Node Ratio in Patients with Resected Synchronous Colorectal Liver Metastases and Less Than 12 Examined Lymph Nodes. J Gastrointest Surg 2022; 26:141-149. [PMID: 34258674 DOI: 10.1007/s11605-021-05079-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies suggest that lymph node ratio (LNR) has significantly better prognostic power than N-status in patients with colorectal cancer, in particular when the number of evaluated lymph nodes (LNs) was insufficient. The aim of this study was to assess the prognostic value of LNR in patients with resected synchronous colorectal liver metastases (SCLMs) and less than 12 examined LNs. METHODS A prospectively maintained database of patients with resected SCLMs was queried for patients with less than 12 LNs evaluated at the time of surgery. X-tile software was used to determine the LNR cutoff value able to divide the patients in two subgroups with distinct prognosis. Overall survival (OS) and disease-free survival (DFS) rates were compared by log-rank test. A multivariate Cox regression analysis identified independent prognostic factors. RESULTS A cutoff LNR value of 0.22 divided patients into Low-LNR group (35 patients) and High-LNR group (36 patients). Both OS and DFS rates were significantly higher in Low-LNR group than those in High-LNR group. Independent predictors of poor OS were High-LNR (HR: 2.841, 95% CI: 1.480-5.453, p value = 0.002), bilobar SCLMs (HR: 2.253, 95% CI: 1.144-4.437, p value = 0.019) and lack of adjuvant chemotherapy (HR: 2.702, 95% CI: 1.448-5.043, p value = 0.002), while the only independent predictor of poor DFS was High-LNR (HR: 2.531, 95% CI: 1.259-5.090, p value = 0.009). CONCLUSIONS LNR > 0.22 was independently associated with poor OS and DFS in patients with resected SCLMs and less than 12 evaluated LNs.
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Affiliation(s)
- Sorin Tiberiu Alexandrescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania.
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Florin M Selaru
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrei S Diaconescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian A Zlate
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
| | - Diana Blanita
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
| | - Razvan T Grigorie
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
| | - Narcis O Zarnescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vlad Herlea
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Irinel Popescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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Chen K, Collins G, Wang H, Toh JWT. Pathological Features and Prognostication in Colorectal Cancer. Curr Oncol 2021; 28:5356-5383. [PMID: 34940086 PMCID: PMC8700531 DOI: 10.3390/curroncol28060447] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
The prognostication of colorectal cancer (CRC) has traditionally relied on staging as defined by the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) TNM staging classifications. However, clinically, there appears to be differences in survival patterns independent of stage, suggesting a complex interaction of stage, pathological features, and biomarkers playing a role in guiding prognosis, risk stratification, and guiding neoadjuvant and adjuvant therapies. Histological features such as tumour budding, perineural invasion, apical lymph node involvement, lymph node yield, lymph node ratio, and molecular features such as MSI, KRAS, BRAF, and CDX2 may assist in prognostication and optimising adjuvant treatment. This study provides a comprehensive review of the pathological features and biomarkers that are important in the prognostication and treatment of CRC. We review the importance of pathological features and biomarkers that may be important in colorectal cancer based on the current evidence in the literature.
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Affiliation(s)
- Kabytto Chen
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Westmead 2145, Australia; (G.C.); (H.W.)
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Westmead 2145, Australia
| | - Geoffrey Collins
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Westmead 2145, Australia; (G.C.); (H.W.)
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Westmead 2145, Australia
| | - Henry Wang
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Westmead 2145, Australia; (G.C.); (H.W.)
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Westmead 2145, Australia
| | - James Wei Tatt Toh
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Westmead 2145, Australia; (G.C.); (H.W.)
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Westmead 2145, Australia
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Chen YC, Tsai HL, Li CC, Huang CW, Chang TK, Su WC, Chen PJ, Yin TC, Huang CM, Wang JY. Critical reappraisal of neoadjuvant concurrent chemoradiotherapy for treatment of locally advanced colon cancer. PLoS One 2021; 16:e0259460. [PMID: 34727133 PMCID: PMC8562787 DOI: 10.1371/journal.pone.0259460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Locally advanced colon cancer (LACC) is associated with surgical challenges during R0 resection, increased postoperative complications, and unfavorable treatment outcomes. Neoadjuvant concurrent chemoradiotherapy followed by surgical resection is an effective treatment strategy that can increase the complete surgical resection rate and improve the patient survival rate. This study investigated the efficacy and toxicity of concurrent chemoradiotherapy in patients with LACC as well as the prognosis and long-term clinical outcomes of these patients. MATERIALS From January 2012 to July 2020, we retrospectively reviewed the real-world data of 75 patients with LACC who received neoadjuvant concurrent chemoradiotherapy. The chemotherapy regimen consisted of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX). The following data were obtained from medical records: patients' characteristics, pathologic results, toxicity, and long-term oncologic outcome. RESULTS Of the 75 patients, 13 (17.3%) had pathologic complete responses. Hematologic adverse effects were the most common (grade 1 anemia: 80.0% and leukopenia: 82.7%). Conversely, grade 2 or 3 adverse effects were relatively uncommon (<10%). Pathologic N downstaging, ypT0, and pathologic complete responses were significant prognostic factors for patient survival. Multivariate analysis revealed that pathologic N downstaging was an independent predictor of patients' overall survival (P = 0.019). The estimated 5-year overall and disease-free survival rates were 68.6% and 50.6%, and the medians of overall and disease-free survival periods were 72.3 and 58.7 months, respectively. Moreover, patients with pathologic complete responses had improved overall survival (P = 0.039) and an improved local recurrence control rate (P = 0.042) but an unfavorable distant metastasis control rate (P = 0.666) in the long-term follow-up. CONCLUSION The long-term oncologic outcome of patients with LACC following concurrent chemoradiotherapy is acceptable, and the adverse effects seem to be tolerable. Pathologic N downstaging was an independent prognostic factor for patients' overall survival. However, a large prospective, randomized control study is required to confirm the current results.
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Affiliation(s)
- Yen-Cheng Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine; Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chun Li
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine; Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Jung Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Chieh Yin
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ming Huang
- Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Radiation Oncology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine; Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
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10
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Maffioli A, Danelli P. Carbon nanoparticles application during colorectal cancer surgery: Updates from China. Dig Liver Dis 2020; 52:1443-1444. [PMID: 33097428 DOI: 10.1016/j.dld.2020.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Maffioli
- University of Milan, Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Piergiorgio Danelli
- University of Milan, Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy
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11
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Han L, Mo S, Xiang W, Li Q, Wang R, Xu Y, Dai W, Cai G. Prognostic accuracy of different lymph node staging system in predicting overall survival in stage IV colon cancer. Int J Colorectal Dis 2020; 35:317-322. [PMID: 31858220 DOI: 10.1007/s00384-019-03486-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE With emphasis of surgical management, the lymph node (LN) status has been advocated to predict prognosis in colon cancer with distant metastatic. Therefore, we tend to compare the prognostic performance of American Joint Committee on Cancer (AJCC) N-staging relative to lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS), and N-score in stage IV colon cancer. METHODS About 20,961 patients who underwent primary surgical resection for stage IV colon cancer were extracted from Surveillance, Epidemiology, and End Results (SEER) Program database. Harrell's C statistic (C-index) and Akaike's Information Criterion (AIC) were used to distinguish the prognostic performance of the different LN-staging schemes. RESULTS Of the 20,961 patients, 17,043 (81.3%) had been with lymph node metastasis, and the median number of examined lymph nodes (ELNs) was 15. When assessed as continuous values, the LODDS shown as the best system with greatest discriminatory power (C-index, 0.6241; AIC, 29114.29) generally and each subgroups divided by ELNs. When modeled as categorical cutoff variables for further clinical usage, the 8th AJCC N-stage outperformed the other three schemes with either ELNs less than 12 (C-index, 0.5770; AIC, 8992.638), between 12 and 25 (C-index, 0.6084; AIC, 13905.72), or more than 25(C-index, 0.6192; AIC, 3138.018) with increasing C-index and less AIC value. CONCLUSIONS When assessed as categorical variables, N-stage performed superiorly regardless of ELNs. When assessed as a continuous variable, LODDS exhibited good discriminative ability and goodness of fit in predicting survival for colon cancer patients regardless of ELNs.
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Affiliation(s)
- Lingyu Han
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shaobo Mo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wenqiang Xiang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Renjie Wang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Weixing Dai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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12
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Russolillo N, Sperti E, Langella S, Menonna F, Allieta A, Di Maio M, Ferrero A. Impact of primary tumor location on patterns of recurrence and survival of patients undergoing resection of liver metastases from colon cancer. HPB (Oxford) 2020; 22:116-123. [PMID: 31235431 DOI: 10.1016/j.hpb.2019.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/25/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several studies have described a worse prognosis for right-sided colon cancer compared to left-sided. The aim of this study was to compare patterns of recurrence and survival following resection of liver metastases (LM) from right-sided (RS) versus left-sided (LS) colon cancer. METHODS Patients undergoing resection for colon cancer LM between 2000 and 2017 were analyzed. Rectal cancer, multiple primaries and unknown location were excluded. RESULTS Out of 995 patients, 686 fulfilled inclusion criteria (RS-LM = 322, LS-LM = 364). RS colon cancer had higher prevalence of metastatic lymph nodes (67.4% vs. 57.1%, P = 0.008). RS-LM were more often mucinous (16.8% vs. 8.5%, P = 0.001) and G3 (58.3% vs. 48.9%, P = 0.014). 451 (65.7%) patients experienced recurrence (RS-LM 68.9% vs. LS-LM 62.9%). In RS-LM group, recurrence was more often encephalic (2.3% vs. 0%, P = 0.029) and at multiple sites (34.2% vs. 23.5%, P = 0.012). The rate of re-resection was lower in RS-LM patients (27.9% vs. 37.5%, P = 0.024). Multivariate analysis showed RS-LM to have worse 5-year overall (35.8% vs. 51.2%, P = 0.002) and disease-free survival (26% vs. 43.6%, P = 0.002). CONCLUSIONS RS-LM is associated with worse survival and aggressive recurrences, with lower chance of re-resection.
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Affiliation(s)
- Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy.
| | - Elisa Sperti
- Department of Oncology, Mauriziano Hospital, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Francesca Menonna
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Andrea Allieta
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Massimo Di Maio
- Department of Oncology, Mauriziano Hospital, Turin, Italy; Department of Oncology, University of Turin, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
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13
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Jiang C, Wang F, Guo G, Dong J, Liu S, He W, Zhang B, Xia L. Metastatic lymph node ratio as a prognostic indicator in patients with stage IV colon cancer undergoing resection. J Cancer 2019; 10:2534-2540. [PMID: 31258759 PMCID: PMC6584347 DOI: 10.7150/jca.29216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/05/2019] [Indexed: 01/01/2023] Open
Abstract
Background: It has been shown that the metastatic lymph node ratio (LNR, metastatic LNs divided by the total number of retrieved LNs) significantly affects the prognosis of patients with non-stage IV and some curative stage IV colon cancer undergoing curative resection. In this study, we aimed to evaluate the role of the LNR as a predictor of prognosis in patients with stage IV colon cancer undergoing curative or palliative resection. Patients and Methods: We conducted a retrospective study of 424 patients who were initially diagnosed with stage IV colon cancer at the Sun Yat-Sen University Cancer Center from 2003 to 2014. The patients were divided into the curative and palliative primary tumor resection groups with regional lymph nodes harvest. The median value was used as the cutoff for the LNR. Overall survival (OS) was assessed with the Kaplan-Meier method and log-rank test. Multivariate analysis was performed to identify the prognostic factors for OS. Results: The cutoff value for the LNR was 0.2. A total of 71 and 353 patients were classified as being in the curative and palliative resection groups, respectively. Patients in the palliative resection group showed higher pretreatment levels of carbohydrate antigen 19-9 (CA199; P = 0.014), a deeper infiltration of the primary tumor (P = 0.049), a lower regional lymph node harvest (i.e., total lymph node yield [TLN] ≤ 11; P = 0.001), and more extensive metastasis (P = 0.006). Among all patients, initial elevated CA199 levels, a TLN≤11, a negative lymph nodes (NLN) ≤7, and a LNR ≤0.2 were significantly associated with an unfavorable prognosis. OS was significantly longer in patients with a low LNR in both groups (P = 0.008 and P = 0.001, respectively). The LNR was an independent prognostic indicator in patients with stage IV colon cancer, with a hazard ratio (HR) of 1.47 (95% confidence interval [CI] 1.14-1.91; P = 0.003) in total population, and an HR of 1.43 (95% CI 1.09-1.86; P = 0.009) in patients with palliative resection. Conclusion: The LNR can be used as an independent prognostic factor in patients with stage IV colon cancer patients undergoing resection.
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Affiliation(s)
- Chang Jiang
- VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, R.P. China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, R.P. China
| | - Guifang Guo
- VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, R.P. China
| | - Jun Dong
- VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, R.P. China
| | - Shousheng Liu
- VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, R.P. China
| | - Wenzhuo He
- VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, R.P. China
| | - Bei Zhang
- VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, R.P. China
| | - Liangping Xia
- VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, R.P. China
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14
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Pei JP, Zhang CD, Fan YC, Dai DQ. Comparison of Different Lymph Node Staging Systems in Patients With Resectable Colorectal Cancer. Front Oncol 2019; 8:671. [PMID: 30697530 PMCID: PMC6340930 DOI: 10.3389/fonc.2018.00671] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: Currently, the United States Joint Commission on Cancer (AJCC) N staging, lymph node positive rate (LNR), and log odds of positive lymph nodes (LODDS) are the main lymph node (LN) staging systems. However, the type of LN staging system that is more accurate in terms of prognostic performance remains controversial. We compared the prognostic accuracy of the three staging systems in patients with CRC and determine the best choice for clinical applications. Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, 56,747 patients were identified who were diagnosed with CRC between 2004 and 2013. Akaike's Information Criterion (AIC) and Harrell's Consistency Index (c-index) were used to assess the relative discriminative abilities of different LN staging systems. Results: In 56,747 patients, when using classification cut-off values for evaluation, the LNR of Rosenberg et al. showed significantly better predictive power, especially when the number of dissected lymph nodes (NDLN) were insufficient. When analyzed as a continuous variable, the LODDS staging system performed the best and was not affected by the NDLN. Conclusions: We suggest that the LNR of Rosenberg et al. should be introduced into the AJCC system as a supplement when the NDLN is insufficient until the optimal LODDS cut-off values are calculated.
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Affiliation(s)
- Jun-Peng Pei
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yu-Chen Fan
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Dong-Qiu Dai
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Cancer Center, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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15
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Li Destri G, Barchitta M, Pesce A, Latteri S, Bosco D, Di Cataldo A, Agodi A, Puleo S. Predictive Value of the Number of Harvested Lymph Nodes and Cut-Off for Lymph Node Ratio in the Prognosis of Stage II and III Colorectal Cancer Patients. J INVEST SURG 2019; 32:1-7. [PMID: 28972442 DOI: 10.1080/08941939.2017.1369605] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED Purpose/aim: The appropriate staging of colorectal cancer requires at least 12 lymph nodes to be sampled. We evaluated whether lymph node sampling (LNS) and lymph node ratio (LNR) can predict the prognosis of stage II-III patients. MATERIALS AND METHODS This is a retrospective study on 432 patients classified in LNS ≥12 and LNS <12. Disease-free survival (DFS) was computed using the Kaplan-Meier method. We stratified stage III patients into 4 quartiles base on LNR values. To determine the optimal LNR cut-off, receiver operating characteristic (ROC) curve analysis was performed. RESULTS There was a positive association between the number of lymph node sampled and the number of metastatic lymph nodes (p < 0.01). Among stage II patients, the DFS was 81% for LNS ≥ 12 and 72% for LNS < 12 (p = 0.158). Among stage III patients, the DFS was 58% (p < 0.001). We found a significant association between LNR quartiles and relapse in stage III patients but only in the LNS ≥ 12 group. ROC curve analysis indicated an ideal LNR cut-off value at 0.194 (sensitivity 65% and specificity 61%). The DFS of patients with LNR below 0.194 was 71%, and that of patients with LNR above 0.194 was 45% (log-rank test, p < 0.001). In the patients with LNS ≥ 12, the cut-off of 0.257 could predict recurrence (specificity 86%). CONCLUSIONS Stage II patients with LNS < 12 tend to have shorter DFS than stage II patients with LNS ≥ 12. In stage III patients, an appropriate LNR cut-off is a better prognostic predictor than LNR quartile, especially in patients with LNS ≥ 12.
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Affiliation(s)
- Giovanni Li Destri
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Martina Barchitta
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Antonio Pesce
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Saverio Latteri
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Dorotea Bosco
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Antonio Di Cataldo
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Antonella Agodi
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Stefano Puleo
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
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16
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Shin H, Kim CW, Lee JL, Yoon YS, Park IJ, Lim SB, Yu CS, Kim JC. Solitary colorectal liver metastasis after curative intent surgery: prognostic factors affecting outcomes and survival. ANZ J Surg 2018; 89:61-67. [PMID: 30484933 DOI: 10.1111/ans.14933] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/16/2018] [Accepted: 10/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to identify the prognostic factors affecting recurrence and survival in patients who underwent curative intent surgery for colorectal cancer (CRC) with a single liver metastasis. METHODS Between January 2006 and August 2012, we retrospectively evaluated 141 patients for CRC with single liver metastasis underwent curative intent surgery for colon and liver simultaneously. Some patients (11.3%) had radiofrequency ablation as an option. RESULTS The 5-year disease-free and overall survival (OS) rates were 38.9% and 59.6%, respectively. Recurrence occurred in 77 (54.6%) patients after surgery. Multivariate analysis identified node positivity and no adjuvant chemotherapy as independent risk factors for OS. We analyzed the OS risk factors in 76 recurred patients from the time of recurrence. Multivariate analysis revealed the following significant risk factors for OS after recurrence: a high serum carcinoembryonic antigen concentration at the time of recurrence, the treatment type after recurrence (chemotherapy or no treatment) and a left hepatic metastasis. CONCLUSION Patients who underwent a curative resection for CRC with a single liver metastasis had a relatively favourable prognosis; in these patients, node positivity and no adjuvant chemotherapy were independent prognostic factors for OS. Furthermore, a high serum carcinoembryonic antigen concentration at the time of recurrence, the treatment type after recurrence (chemotherapy or no treatment) and a left hepatic metastasis may be independent prognostic factors for OS in patients with recurrence. The left hepatic metastasis group tended to have a multiple hepatic relapse more frequently than the right hepatic metastasis group in cases of isolated hepatic relapse.
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Affiliation(s)
- Heeji Shin
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
| | - Chan Wook Kim
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
| | - Jong Lyul Lee
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
| | - Yong Sik Yoon
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
| | - In Ja Park
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
| | - Seok-Byung Lim
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
| | - Chang Sik Yu
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
| | - Jin Cheon Kim
- Department of Surgery, University of Ulsan College of Medicine, Institute of Innovative Cancer Research, and Asan Medical Center, Seoul, South Korea
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17
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Brudvik KW, Søreide K. Association between the lymph node ratio and hepatic tumor burden: importance for resectable colorectal liver metastases? Hepatobiliary Surg Nutr 2018; 7:206-208. [PMID: 30046575 DOI: 10.21037/hbsn.2018.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Kjetil Søreide
- Hepatobiliary and Pancreatic Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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18
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Deng Y, Peng J, Zhao Y, Sui Q, Zhao R, Lu Z, Qiu M, Lin J, Pan Z. Lymph node ratio as a valuable prognostic factor for patients with colorectal liver-only metastasis undergoing curative resection. Cancer Manag Res 2018; 10:2083-2094. [PMID: 30140159 PMCID: PMC6054757 DOI: 10.2147/cmar.s169029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Recent studies have suggested that the lymph node ratio (LNR) is a prognostic indicator for various malignancies. However, LNR has not been evaluated in colorectal liver-only metastasis (CRLM). This study aimed to investigate the prognostic value of LNR in patients with CRLM after curative resection. Patients and methods We retrospectively investigated the clinicopathologic features of 154 CRLM patients who underwent curative resection between 2005 and 2015. We classified patients into low and high groups based on their LNR by using the X-tile software. Survival curves were plotted through Kaplan–Meier method and compared by log-rank test. Cox proportional hazards analysis was performed to identify the factors associated with recurrence-free survival (RFS) and overall survival (OS). Results The patients were divided into two groups in which 124 patients were identified as LNR ≤0.33 and 30 patients as LNR >0.33. Compared to low LNR, high LNR was significantly associated with poor 3-year RFS (47.2% vs 16.7%, P=0.001) and OS (72.8% vs 45.3%, P=0.003) rates. Multivariate analysis indicated that the LNR was an independent predictor for 3-year RFS (hazard ratio, 2.124; 95% CI, 1.339–3.368; P=0.001) and OS (HR, 2.287; 95% CI, 1.282–4.079; P=0.005). However, the node (N) stage and lymph node distribution were not significantly associated with the 3-year RFS (P=0.071, P=0.226) or OS (P=0.452, P=0.791) in patients with CRLM. Conclusion This study demonstrated that LNR was an independent predictor for 3-year RFS and OS in patients with CRLM who underwent curative resection and that its prognostic value was superior to that of N stage and lymph node distribution.
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Affiliation(s)
- Yuxiang Deng
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Jianhong Peng
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Yujie Zhao
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Qiaoqi Sui
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Ruixia Zhao
- Department of Public Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhenhai Lu
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Miaozhen Qiu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Junzhong Lin
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Zhizhong Pan
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
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Abstract
Pathologic examination of lymph nodes in patients with cancer remains crucial for postoperative treatment and prognosis prediction. In this article, the authors aim to review several important and challenging issues regarding lymph node metastasis in colorectal cancer using the AJCC staging manual, College of American Pathologists cancer protocol, as well as the literature. These topics include lymph node staging, the definition and controversies in tumor deposits, isolated tumor cells in lymph node and micrometastasis, lymph node ratio as a prognostic stratification factor, and neoadjuvant treatment effect in rectal cancer. Updates from the most recent AJCC 8th edition are included.
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Affiliation(s)
- Ming Jin
- Department of Pathology, The Ohio State University Wexner Medical Center, S305E Rhodes Hall, 450 West 10th Avenue, Columbus, OH 43210, USA
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, 129 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.
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20
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Li Q, Wang C, Li Y, Li X, Xu Y, Cai G, Lian P, Cai S. Lymph node status as a prognostic factor after palliative resection of primary tumor for patients with metastatic colorectal cancer. Oncotarget 2017; 8:48333-48342. [PMID: 28430643 PMCID: PMC5564651 DOI: 10.18632/oncotarget.15696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/20/2017] [Indexed: 12/14/2022] Open
Abstract
Lymph node (LN) status is one of the most important predictors for M0 colorectal cancer patients. However, its clinical impact on stage IV colorectal cancer remains unclear. The study aimed to explore the prognostic value of LN status after palliative resection of primary tumor for patients with metastatic colorectal cancer (mCRC). We combined analyses of mCRC patients in Surveillance, Epidemiology and End Results (SEER) database and Fudan University Shanghai Cancer Center (FUSCC).A total of 17,553 patients with mCRC were identified in SEER database. X-tile program was adopted to identify 2 and 10 as optimal cutoff values for negative lymph node (NLN) count to divide patients into 3 subgroups of high, middle and low risk of cancer related death. N stage and NLN count were verified as independent prognostic factors in multivariate analyses of patients in whole cohort and in subgroup analyses of each N stage (P<0.05). Validation of FUSCC cohort of patients demonstrated that metastatic tumor burden (P = 0.042), NLN count (P = 0.039) and sequential chemotherapy (P = 0.040) were significant predictors of poorer CSS. Specifically, the prognosis of patients at stage N0 was significantly more favorable than that of patients at stage N2 (P = 0.038). In conclusion, primary tumor LN status was a strong predictor of CSS after palliative resection of metastatic colorectal cancer. Advanced N stage and small number of NLN were correlated with high risk of cancer related death after palliative resection of primary tumor.
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Affiliation(s)
- Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Changjian Wang
- Anorectal Department, Hangzhou Third Hospital, Hangzhou, China
| | - Yaqi Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinxiang Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Anorectal Department, Hangzhou Third Hospital, Hangzhou, China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Peng Lian
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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21
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Byrling J, Andersson R, Sasor A, Lindell G, Ansari D, Nilsson J, Andersson B. Outcome and evaluation of prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma. Ann Gastroenterol 2017; 30:571-577. [PMID: 28845114 PMCID: PMC5566779 DOI: 10.20524/aog.2017.0169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/29/2017] [Indexed: 12/26/2022] Open
Abstract
Background The aim of the present study was to examine the outcomes and prognostic factors after surgery with curative intent for distal cholangiocarcinoma during a modern timespan, in a Swedish tertiary referral center. Methods All patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma between April 2008 and December 2015 were identified. Survival was estimated using the Kaplan-Meier analysis. Demographic, clinical, laboratory and histopathological data were evaluated for prognostic factors relating to mortality, using univariable and multivariable statistical analysis. Results Fifty-four patients were included. The mean age was 68±8 years and 21 (39%) of the patients were female. Jaundice was present at diagnosis in 73% of the patients. There was no 90-day mortality. Complications graded as Clavien-Dindo ≥3 occurred in 10 (19%) of the patients. Twenty-eight (52%) received adjuvant therapy. Overall survival rates at 1, 3, and 5 years were 80%, 21%, and 9.2%, respectively. Median survival was 22.2 months. The presence of lymph node metastases was found to be the only independent predictor of survival (hazard ratio 2.88, 95% confidence interval 1.22-6.84; P=0.016). The total number of lymph node metastases, lymph node ratio or total number of resected nodes did not improve the prediction. Conclusions We found that the recurrence rate was higher and the survival poorer after surgery for distal cholangiocarcinoma than has previously been reported. Lymph node status at the time of resection was the most important prognostic factor for survival in the current material.
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Affiliation(s)
- Johannes Byrling
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital (Johannes Byrling, Roland Andersson, Gert Lindell, Daniel Ansari, Bodil Andersson), Sweden
| | - Roland Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital (Johannes Byrling, Roland Andersson, Gert Lindell, Daniel Ansari, Bodil Andersson), Sweden
| | - Agata Sasor
- Department of Pathology, Clinical Sciences Lund, Lund University and Skane University Hospital (Agata Sasor), Sweden
| | - Gert Lindell
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital (Johannes Byrling, Roland Andersson, Gert Lindell, Daniel Ansari, Bodil Andersson), Sweden
| | - Daniel Ansari
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital (Johannes Byrling, Roland Andersson, Gert Lindell, Daniel Ansari, Bodil Andersson), Sweden
| | - Johan Nilsson
- Department of Cardiothoracic Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital (Johan Nilsson), Sweden
| | - Bodil Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital (Johannes Byrling, Roland Andersson, Gert Lindell, Daniel Ansari, Bodil Andersson), Sweden
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22
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Ahmad A, Reha J, Saied A, Espat NJ, Somasundar P, Katz SC. Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer. Hepatobiliary Surg Nutr 2017; 6:154-161. [PMID: 28652998 DOI: 10.21037/hbsn.2016.08.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The primary objective of our study was to assess the association of primary tumor lymph node ratio (LNR) in stage IV colorectal adenocarcinomas (CRC) with overall survival (OS) and the extent of metastatic disease in the liver. METHODS We analyzed data on 53 stage IV CRC patients who underwent surgical resection of the primary tumor. The median LNR of 0.25 was used to stratify patients into high LNR (H-LNR) and low LNR (L-LNR) groups. Statistical comparison was performed using chi square test and multiple regression models. OS was calculated using the Kaplan-Meier (KM) method while cox regression was used for multivariate analysis. RESULTS H-LNR status was associated with the presence of >3 liver metastases (LM) [odds ratio (OR): 2.43, P=0.047] and bilobar LM (OR: 3.94, P=0.039). The OS in H-LNR patients was significantly worse in the entire cohort compared to L-LNR (9% vs. 34% at 3 years, P=0.027). The 5-year OS in patients undergoing liver resection for LM was also significantly worse in the H-LNR group (0% vs. 37%, P=0.013). LNR was independently associated with survival on multivariate analysis [HR: 2.63; 95% confidence intervals (CI), 1.13-6.14; P=0.025]. CONCLUSIONS In stage IV CRC, LNR is associated with the extent of hepatic tumor burden and was an independent predictor of survival in patients undergoing liver resection.
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Affiliation(s)
- Ali Ahmad
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA
| | - Jeffrey Reha
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA
| | - Abdul Saied
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - N Joseph Espat
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Ponnandai Somasundar
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Steven C Katz
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
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Spelt L, Sasor A, Ansari D, Andersson R. Pattern of tumour growth of the primary colon cancer predicts long-term outcome after resection of liver metastases. Scand J Gastroenterol 2016; 51:1233-8. [PMID: 27306604 DOI: 10.1080/00365521.2016.1190400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify significant predictive factors for overall survival (OS) and disease-free survival (DFS) after liver resection for colon cancer metastases, with special focus on features of the primary colon cancer, such as lymph node ratio (LNR), vascular invasion, and perineural invasion. METHODS Patients operated for colonic cancer liver metastases between 2006 and 2014 were included. Details on patient characteristics, the primary colon cancer operation and metastatic disease were collected. Multivariate analysis was performed to select predictive variables for OS and DFS. RESULTS Median OS and DFS were 67 and 20 months, respectively. 1-, 3- and 5-year OS were 97, 76, and 52%. 1-, 3- and 5-year DFS were 65, 42, and 37%. Multivariate analysis showed LNR to be an independent predictive factor for DFS but not for OS. Other identified predictive factors were vascular and perineural invasion of the primary colon cancer, size of the largest metastasis and severe complications after liver surgery for OS, and perineural invasion, number of liver metastases and preoperative CEA-level for DFS. Traditional N-stage was also considered to be an independent predictive factor for DFS in a separate multivariate analysis. CONCLUSIONS LNR and perineural invasion of the primary colon cancer can be used as a prognostic variable for DFS after a concomitant liver resection for colon cancer metastases. Vascular and perineural invasion of the primary colon cancer are predictive for OS.
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Affiliation(s)
- Lidewij Spelt
- a Department of Surgery , Clinical Sciences Lund, Lund University and Skåne University Hospital , Lund , Sweden
| | - Agata Sasor
- b Department of Pathology , Skåne University Hospital , Lund , Sweden
| | - Daniel Ansari
- a Department of Surgery , Clinical Sciences Lund, Lund University and Skåne University Hospital , Lund , Sweden
| | - Roland Andersson
- a Department of Surgery , Clinical Sciences Lund, Lund University and Skåne University Hospital , Lund , Sweden
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24
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Clinical Significance of International Union Against Cancer pN Staging and Lymph Node Ratio in Node-Positive Colorectal Cancer after Advanced Lymph Node Dissection. Dis Colon Rectum 2016; 59:386-95. [PMID: 27050600 DOI: 10.1097/dcr.0000000000000569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lymph node retrieval in colorectal cancer can be improved by using advanced histopathological techniques like methylene blue-assisted lymph node dissection, which results in a doubling or even tripling of the lymph node count in comparison with conventional lymph node dissection techniques. However, it is not clear whether the established lymph node staging systems are suitable for predicting patients' prognoses under these circumstances. OBJECTIVE The aim of this study was to determine whether the current lymph node staging systems are suitable when advanced dissection methods are used. DESIGN This is a retrospective cohort study. SETTING AND PATIENTS We formed a study group (methylene blue-assisted lymph node dissection) of 293 patients and a control group (conventional lymph node dissection) of 232 patients, each with node-positive cases. Conventional pN staging according to the International Union Against Cancer, seventh edition, and lymph node ratio were applied. MAIN OUTCOME MEASURES Overall survival was compared by using the different staging systems in a uni- and multivariable fashion. RESULTS The lymph node ratio values were reduced in the advanced methylene blue-assisted lymph node dissection group in comparison with the conventional lymph node dissection group (0.1 vs 0.3, p < 0.001). Although pN staging proved to be reliable, the cutoff values for lymph node ratio staging had to be adapted. The new cutoffs (0.07, 0.15, and 0.34) were prognostic. However, multivariable analysis revealed pN staging and vascular invasion, but not lymph node ratio, as independently prognostic in the methylene blue-assisted lymph node dissection group. LIMITATIONS The study group and historical control group are not perfectly balanced because the case number in the stage III subgroup of the control group is small. CONCLUSIONS pN staging proved to be a robust prognostic marker in colorectal cancer under the circumstances of improved lymph node harvest. After adaptation of the cutoff values, lymph node ratio is also prognostic but not superior to pN staging.
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25
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Li MX, Jin ZX, Zhou JG, Ying JM, Liang ZY, Mao XX, Bi XY, Zhao JJ, Li ZY, Huang Z, Zhang YF, Li Y, Chen X, Hu XH, Hu HJ, Zhao DB, Wang YY, Cai JQ, Zhao H. Prognostic Value of Lymph Node Ratio in Patients Receiving Combined Surgical Resection for Gastric Cancer Liver Metastasis: Results from Two National Centers in China. Medicine (Baltimore) 2016; 95:e3395. [PMID: 27100426 PMCID: PMC4845830 DOI: 10.1097/md.0000000000003395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to evaluate the prognostic value of lymph node ratio (LNR) in patients with gastric cancer liver metastasis (GCLM) who received combined surgical resection. A retrospective analysis of 46 patients from two hospitals was conducted. Patients were dichotomized into two groups (high LNR and low LNR) by the median value of LNR. The overall survival (OS) and recurrence-free survival (RFS) were analyzed by the Kaplan-Meier method with the log-rank test. The Cox proportional hazard model was used to carry out the subsequent multivariate analyses. And the relationship between LNR and clinicopathological characteristics was assessed. The cut-off value defining elevated LNR was 0.347. With a median follow-up of 67.5 months, the median OS and RFS of the patients were 17 and 9.5 months, respectively. Six patients survived for >5 years after surgery. Patients with higher LNR had significantly shorter OS and RFS than those with lower LNR. In the multivariate analyses, higher LNR and multiple liver metastatic tumors were identified as the independent prognostic factors for both OS and RFS. Elevated LNR was significantly associated with advanced pN stage (P <0.001), larger primary tumor size (P = 0.046), the presence of microvascular invasion (P = 0.008), and neoadjuvant chemotherapy (P = 0.004). LNR may be prognostic indicator for patients with GCLM treated by synchronous surgical resection. Patients with lower LNR and single liver metastasis may gain more survival benefits from the surgical resection. Further prospective studies with reasonable study design are warranted.
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Affiliation(s)
- Mu-Xing Li
- From the Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 17, Panjiayuan Nanli (M-XL, Z-XJ, J-GZ, X-YB, J-JZ, Z-YL, ZH, Y-FZ, YL, XC, X-HH, H-JH, D-BZ, J-QC, HZ); Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1 ShuaiFuYuan Hutong (Y-YW); Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No.17, Panjiayuan Nanli (J-MY); Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1 ShuaiFuYuan Hutong (Z-YL, X-XM); and Peking Union Medical College, Chinese Academy of Medical Sciences, No. 5 DongDanSanTiao, Beijing, People's Republic of China (Z-XJ)
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