Impact of negative lymph nodes on colon cancer survival and exploring relevant transcriptomics differences through real-world data analyses

Clinicopathological characteristics and prognosis of colon cancer with lung metastasis without liver metastasis: A large population-based analysis

Distant metastasis explains the high mortality rate of colon cancer, in which lung metastasis without liver metastasis (LuM) is a rare subtype. This study is aimed to identify risk factors of LuM and LLM (lung metastasis with liver metastasis) from colon cancer, and to analyze the prognosis of patients with LuM by creating a nomogram. Patients' information were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression analysis was used to determine the risk factors for LuM and LLM. Prognostic factors for cancer-specific survival (CSS) and overall survival (OS) were identified by multivariate Cox proportional hazards regression and nomogram models were established to predict CSS and OS. Multivariate logistic regression analysis showed that blacks, splenic flexure of colon tumor, tumor size >5 cm, T4, N3, and higher lymph node positive rate were associated with the occurrence of LuM. Meanwhile, age >65 years old, female, splenic flexure of colon, higher lymph node positive rate, and brain metastasis were independent risk factors for CSS. The C-index of the prediction model for CSS was 0.719 (95% CI: 0.691-0.747). In addition, age, primary site, tumor size, differentiation grade, N stage, and bone metastasis were significantly different between LuM and LLM. The nomograms we created were effective in predicting the survival of individuals. Furthermore, patients with LuM and LLM from colon cancer might require different follow-up intervals and examinations.

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

Negative lymph node count is an independent prognostic factor for female patients with node positive breast cancer

Background

Negative lymph node (NLN) count has been reported to associate with the prognosis of various cancers. This study aims to reveal the prognostic value of NLN count in breast cancer.

Methods

Clinical characteristics of patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The X-tile program was used to determine the optimal cutoffs for NLN count. Univariate and multivariate analysis were used to assess the risk factors for breast cancer-specific survival (BCSS).

Results

The X-tile program identified that cutoff value of 2 and 10 could divide the patients into high, middle and low risk subgroups. According to multivariate analysis, patients with NLN count ≤1, over 60 years old, being black, higher tumor grade, higher T or N stage, negative hormone receptor, no radiotherapy or no chemotherapy would more likely suffer poor survival outcome. Subgroup analysis showed that NLN count could still predict survival independently.

Conclusions

NLN count is a potentially effective predictor of breast cancer and is a good supplement for N stage and TNM stage. Combining NLN count with other prognostic factors will be a better predictor for the survival of breast cancer patients.

Ratio between negative and positive lymph nodes is a novel prognostic indicator for patients with esophageal cancer: A Surveillance, Epidemiology and End Results database analysis

Background

The aim of this study was to explore whether the ratio between negative and positive lymph nodes (R_NP) could predict the overall survival (OS) of esophageal cancer (EC) patients with lymph node metastasis following esophagectomy.

Methods

We utilized the Surveillance, Epidemiology and End Results (SEER) database to include the records of 2374 patients with lymph node metastases post‐surgery. All patients were randomly assigned into the training cohort (n = 1424) and validation cohort (n = 950). Multivariate Cox regression analyses were performed to identify independent prognostic factors. A novel R_NP ‐based TR_NPM staging system was proposed. The prognostic value of N, R_NP, TNM and TR_NPM staging system was evaluated using the linear trend χ² test, likelihood ratio χ² test, and Akaike information criterion (AIC) to determine the potential superiorities. We constructed nomograms to predict survival in both cohorts, and the calibration curves confirmed the predictive ability.

Results

Univariate analyses showed that N and R_NP stage significantly influenced the OS of patients. Multivariate analyses revealed that R_NP was an independent prognostic predictor in both the training and validation cohorts. For the stratification analysis in the two cohorts, we found significant differences in the prognosis of patients in different R_NP groups on the basis of the different N stages and the number of dissected lymph nodes. In addition, the lower AIC value of R_NP stage and TR_NPM staging system represented superior predictive accuracy for OS than the N stage and TNM staging system, respectively. Furthermore, the calibration curves for the probability of three‐ and five‐year survival showed good consistency between nomogram predictive abilities and actual observation.

Conclusions

We demonstrated that compared to the classical pathological lymph nodal staging system, the R_NP stage showed superior predictive accuracy for OS and can serve as a more effective prognostic guidance for lymph node positive EC patients.