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Han Z, Yang H, Qiao Q, Wu T, He X, Wang N. The survival prediction of advanced colorectal cancer received neoadjuvant therapy-a study of SEER database. World J Surg Oncol 2024; 22:175. [PMID: 38951795 PMCID: PMC11218294 DOI: 10.1186/s12957-024-03458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE The aim of study was to screen factors associated with the overall survival of colorectal cancer patients with lymph nodes metastasis who received neoadjuvant therapy and construct a nomogram model. METHODS All enrolled subjects of the SEER database were randomly assigned to the training and testing group in a ratio of 3:2. The patients of Tangdu Hospital were seemed as validation group. Univariate cox regression analysis, lasso regression and random forest survival were used to screen variables related to the survival of advanced CRC patients received neoadjuvant therapy in the training group. Area under curves were adopted to evaluate the 1,3,5-year prediction value of the optimal model in three cohorts. Calibration curves were drawn to observe the prediction accuracy of the nomogram model. Decision curve analysis was used to assess the potential clinical value of the nomogram model. RESULTS A total of 1833 subjects were enrolled in this study. After random allocation, 1055 cases of the SEER database served as the training group, 704 cases as the testing group and 74 patients from our center as the external validation group. Variables were screened by univariate cox regression used to construct a nomogram survival prediction model, including M, age, chemotherapy, CEA, perineural invasion, tumor size, LODDS, liver metastasis and radiation. The AUCs of the model for predicting 1-year OS in the training group, testing and validation group were 0.765 (0.703,0.827), 0.772 (0.697,0.847) and 0.742 (0.601,0.883), predicting 3-year OS were 0.761 (0.725,0.780), 0.742 (0.699,0.785), 0.733 (0.560,0.905) and 5-year OS were 0.742 (0.711,0.773), 0.746 (0.709,0.783), 0.838 (0.670,0.980), respectively. The calibration curves showed the difference between prediction probability of the model and the actual survival was not significant in three cohorts and the decision curve analysis revealed the practice clinical application value. And the prediction value of model was better for young CRC than older CRC patients. CONCLUSION A nomogram model including LODDS for the prognosis of advanced CRC received neoadjuvant therapy was constructed and verified based on the SEER database and single center practice. The accuracy and potential clinical application value of the model performed well, and the model had better predictive value for EOCRC than LOCRC.
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Affiliation(s)
- Zhuo Han
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an, 710038, China
| | - Haicheng Yang
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an, 710038, China
| | - Qing Qiao
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an, 710038, China
| | - Tao Wu
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an, 710038, China
| | - Xianli He
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an, 710038, China
| | - Nan Wang
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an, 710038, China.
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E Y, Lu C, Wang Z, Huang Y, Ji P, Luo X, Chu C, Yu C. Evaluation of the prognostic performance of different cutoff values of lymph node ratio staging system for stage III colorectal cancer. Updates Surg 2024:10.1007/s13304-024-01770-1. [PMID: 38530611 DOI: 10.1007/s13304-024-01770-1] [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: 07/21/2023] [Accepted: 01/29/2024] [Indexed: 03/28/2024]
Abstract
This study attempted to compare the prognostic performance of lymph node ratio (LNR) staging system with different cutoff values relative to American Joint Committee on Cancer (AJCC) pN staging system in stage III colorectal cancer (CRC). Overall, 45,069 patients from the SEER dataset and 69 patients from the Second Affiliated Hospital of Nanjing Medical University (the External set) who underwent surgical resection of the primary tumor and were diagnosed with stage III CRC by postoperative pathology were included. Patients were divided into three subgroups based on the LNR cutoff used in previous studies, Kaplan-Meier curves were plotted, and log-rank test was used to compare the differences among groups in terms of cancer-specific survival (CSS). Cox regression model was applied for survival analysis. To evaluate the discriminatory power of different lymph node staging systems, Harrell's C statistic(C-index) and Akaike's Information Criterion (AIC) were applied. A set of optimal cutoff values (0.11; 0.36; 0.66) of LNR staging system with the most considerable discriminatory power to the prognosis in patients with stage III CRC (SEER set: C-index = 0.714; AIC = 58,942.46, External set: C-index = 0.809; AIC = 164.36) were obtained, and both were superior to the AJCC pN staging system (SEER set: C-index = 0.708; AIC = 59,071.20, External set: C-index = 0.788; AIC = 167.06). For evaluating the prognostic efficacy of patients with stage III colorectal cancer, the cutoff value (0.11; 0.36; 0.66) of LNR staging system had the best discrimination and prognostic ability, which was superior to LNR staging system under other cutoff values and AJCC pN staging system.
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Affiliation(s)
- Yimin E
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Chen Lu
- Department of General Surgery, Sir Run Run Hospital Nanjing Medical University, Nanjing, China
| | - Zijun Wang
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Yicheng Huang
- Department of Anorectal Surgery, Suzhou Xiangcheng People's Hospital, Suzhou, China
| | - Pengcheng Ji
- Department of General Surgery, Sir Run Run Hospital Nanjing Medical University, Nanjing, China
| | - Xiagang Luo
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Chaoshun Chu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China.
| | - Chunzhao Yu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China.
- Department of General Surgery, Sir Run Run Hospital Nanjing Medical University, Nanjing, China.
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Li QY, Yang D, Guan Z, Yan XY, Li XT, Sun RJ, Lu QY, Zhang XY, Sun YS. Extranodal Extension at Pretreatment MRI and the Prognostic Value for Patients with Rectal Cancer. Radiology 2024; 310:e232605. [PMID: 38530176 DOI: 10.1148/radiol.232605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background Detection of extranodal extension (ENE) at pathology is a poor prognostic indicator for rectal cancer, but whether ENE can be identified at pretreatment MRI is, to the knowledge of the authors, unknown. Purpose To evaluate the performance of pretreatment MRI in detecting ENE using a matched pathologic reference standard and to assess its prognostic value in patients with rectal cancer. Materials and Methods This single-center study included a prospective development data set consisting of participants with rectal adenocarcinoma who underwent pretreatment MRI and radical surgery (December 2021 to January 2023). MRI characteristics were identified by their association with ENE-positive nodes (χ2 test and multivariable logistic regression) and the performance of these MRI features was assessed (area under the receiver operating characteristic curve [AUC]). Interobserver agreement was assessed by Cohen κ coefficient. The prognostic value of ENE detected with MRI for predicting 3-year disease-free survival was assessed by Cox regression analysis in a retrospective independent validation cohort of patients with locally advanced rectal cancer (December 2019 to July 2020). Results The development data set included 147 participants (mean age, 62 years ± 11 [SD]; 87 male participants). The retrospective cohort included 110 patients (mean age, 60 years ± 9; 79 male participants). Presence of vessel interruption and fusion (both P < .001), heterogeneous internal structure, and the broken-ring and tail signs (odds ratio range, 4.10-23.20; P value range, <.001 to .002) were predictors of ENE at MRI, and together achieved an AUC of 0.91 (95% CI: 0.88, 0.93) in detecting ENE. Interobserver agreement was moderate for the presence of vessel interruption and fusion (κ = 0.46 for both) and substantial for others (κ = 0.61-0.67). The presence of ENE at pretreatment MRI was independently associated with worse 3-year disease-free survival (hazard ratio, 3.00; P = .02). Conclusion ENE can be detected at pretreatment MRI, and its presence was associated with worse prognosis for patients with rectal cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Eberhardt in this issue.
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Affiliation(s)
- Qing-Yang Li
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Ding Yang
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Zhen Guan
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xin-Yue Yan
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xiao-Ting Li
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Rui-Jia Sun
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Qiao-Yuan Lu
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xiao-Yan Zhang
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Ying-Shi Sun
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
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Yavuz A, Buyukkasap C, Altiner S, Kurtoglu B, Koyuncuoglu C, Gobut H, Dikmen K, Bostanci H, Yuksel O. Log odds of positive nodes as a prognostic factor for rectal cancer: a retrospective study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230417. [PMID: 38198298 PMCID: PMC10768676 DOI: 10.1590/1806-9282.2023417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Rectal cancer is an important cause of mortality and morbidity globally. The aim of this study was to investigate whether the log odds of positive nodes system is a better indicator than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis, which is an important cause of mortality and morbidity globally. METHODS This was a single-center retrospective cross-sectional study. Data were obtained from the medical records of patients with rectum adenocarcinoma followed at Gazi University Hospital. The clinicopathological data of 128 patients with rectum adenocarcinoma who underwent low anterior resection or abdominoperineal resection between January 2010 and December 2018 was retrospectively reviewed. Patients with rectum adenocarcinoma as the first and only primary diagnosis, which was confirmed by histopathological examination, than those who had undergone complete curative resection via low anterior resection or abdominoperineal resection were included. Those with familial adenomatous polyposis or Lynch syndrome, those under 18 years of age, with a synchronous tumor, peritoneal spread, or metastatic disease at the time of diagnosis, and those with <12 lymph nodes dissected from the resection material were excluded from the study. RESULTS In multivariate analysis, age, perineural invasion, tumor node metastasis stage, lymph node ratio stage, and log odds of positive nodes stage were found to be independent prognostic factors (p<0.05). LODDS2 patients' mortality rates were 9.495 times higher than LODDS0 patients [hazard ratio=9.495, (95%CI 4.155-21.694), p<0.001] while LNR2 stage patients' mortality rates were 7.016 times higher than LNR0 stage patients [hazard ratio=7.016, (95%CI 3.123-15.765), p<0.001] and N2 stage patients had a 5.135 times higher risk of mortality than those who were in N0 stage [hazard ratio=5.135 (95%CI 2.451-10.756), p<0.001]. CONCLUSION Log odds of positive nodes is a more valuable prognostic factor for rectal cancer patients than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis.
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Affiliation(s)
- Aydin Yavuz
- Gazi University, Faculty of Medicine, Department of General Surgery – Ankara, Turkey
| | - Cagri Buyukkasap
- Gazi University, Faculty of Medicine, Department of General Surgery – Ankara, Turkey
| | - Saygin Altiner
- Ankara Training and Research Hospital, Department of General Surgery – Ankara, Turkey
| | | | - Can Koyuncuoglu
- Gazi University, Faculty of Medicine, Department of General Surgery – Ankara, Turkey
| | - Huseyin Gobut
- Gazi University, Faculty of Medicine, Department of General Surgery – Ankara, Turkey
| | - Kursat Dikmen
- Gazi University, Faculty of Medicine, Department of General Surgery – Ankara, Turkey
| | - Hasan Bostanci
- Gazi University, Faculty of Medicine, Department of General Surgery – Ankara, Turkey
| | - Osman Yuksel
- Gazi University, Faculty of Medicine, Department of General Surgery – Ankara, Turkey
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Benli S, Tazeoğlu D, Çolak T. Combination of the Ratio Between Negative and Harvested Lymph Nodes and Metastatic Lymph Node Count as a Prognostic Indicator in Stage III Colon Cancer: A Retrospective Cohort Study. Am Surg 2024; 90:38-45. [PMID: 37498224 DOI: 10.1177/00031348231192069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND This study aimed to investigate the relationship between the ratio of negative lymph nodes (NLN) number to the number of metastatic lymph nodes (MLN) and the harvested lymph nodes (HLN) number ratio survival rate and compare its prognostic value. METHODS This retrospective cohort study included 207 stage III colon cancer patients between 2010 and 2018 at a single center. NLN/MLN and NLN/HLN cut-off values were determined with the receiver operating characteristic (ROC) curve according to 5-year survival. The patients were divided into high-risk and low-risk groups according to the cut-off value. These 2 groups were evaluated according to the clinicopathological data of the patients. RESULT The time-dependent ROC curve showed the optimal cut-off values of NLN as 3.86 and .79, respectively. These values show 83 patients in the high-risk group and 124 in the low-risk group. There was no difference between the groups in tumor localization and T stage. According to Kaplan-Meier survival analysis, mean survival was 35.88 months in the high-risk group and 50.18 months in the low-risk group. The risk of death in the high-risk group was 305% compared to the low-risk group (Hazard Ratio: 3.05, 95% 1.91 - 4.88) (P < .001). CONCLUSION NLNs are among the critical prognostic factors in colon cancer. Although NLNs have a positive correlation with the survival rate of the patients, there is no statistical difference in tumor T stage and localization.
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Affiliation(s)
- Sami Benli
- Department of Surgery, Division of Surgical Oncology, Mersin University Medical Faculty, Mersin, Turkey
| | - Deniz Tazeoğlu
- Department of Surgery, Division of Surgical Oncology, Mersin University Medical Faculty, Mersin, Turkey
| | - Tahsin Çolak
- Department of Surgery, Division of Surgical Oncology, Mersin University Medical Faculty, Mersin, Turkey
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Zheng HD, Hu YH, Ye K, Xu JH. Development and validation of a nomogram for preoperative prediction of tumor deposits in colorectal cancer. World J Gastroenterol 2023; 29:5483-5493. [PMID: 37900997 PMCID: PMC10600810 DOI: 10.3748/wjg.v29.i39.5483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Based on the clinical data of colorectal cancer (CRC) patients who underwent surgery at our institution, a model for predicting the formation of tumor deposits (TDs) in this patient population was established. AIM To establish an effective model for predicting TD formation, thus enabling clinicians to identify CRC patients at high risk for TDs and implement personalized treatment strategies. METHODS CRC patients (n = 645) who met the inclusion criteria were randomly divided into training (n = 452) and validation (n = 193) cohorts using a 7:3 ratio in this retrospective analysis. Least absolute shrinkage and selection operator regression was employed to screen potential risk factors, and multivariable logistic regression analysis was used to identify independent risk factors. Subsequently, a predictive model for TD formation in CRC patients was constructed based on the independent risk factors. The discrimination ability of the model, its consistency with actual results, and its clinical applicability were evaluated using receiver-operating characteristic curves, area under the curve (AUC), calibration curves, and decision curve analysis (DCA). RESULTS Thirty-four (7.5%) patients with TDs were identified in the training cohort based on postoperative pathological specimens. Multivariate logistic regression analysis identified female sex, preoperative intestinal obstruction, left-sided CRC, and lymph node metastasis as independent risk factors for TD formation. The AUCs of the nomogram models constructed using these variables were 0.839 and 0.853 in the training and validation cohorts, respectively. The calibration curve demonstrated good consistency, and the training cohort DCA yielded a threshold probability of 7%-78%. CONCLUSION This study developed and validated a nomogram with good predictive performance for identifying TDs in CRC patients. Our predictive model can assist surgeons in making optimal treatment decisions.
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Affiliation(s)
- Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yun-Huang Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Zhang C, Zhao S, Wang X, Wen D. A new lymph node ratio-based staging system for rectosigmoid cancer: a retrospective study with external validation. Int J Surg 2023; 109:3087-3096. [PMID: 37462992 PMCID: PMC10583910 DOI: 10.1097/js9.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND This study evaluated the clinical value of a new American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging prediction model based on lymph node ratio (LNR) in rectosigmoid cancer (RSC). METHODS The analysis included 1444 patients with nonmetastatic RSC diagnosed pathologically between 2010 and 2016 who were collected from the National Cancer Institute Surveillance, Epidemiology, and Results database. The AJCC N-stage was redefined according to the LNR cutoff point, and the ability of the new staging system to predict prognosis was compared with that of the AJCC TNM staging system. Data from 739 patients from our hospital were used for external validation. RESULTS According to the number of examined lymph nodes and LNR, the N stage was divided into five groups (LNR0-5). The 5-year OS of patients divided according to the new T lymph node ratio M (TLNRM) staging into stage I (T1LNR1, T1LNR2), IIA (T1LNR3, T2LNR1, T2LNR2, T2LNR3, T1LNR4, T3LNR1), IIB (T2LNR4), IIC (T3LNR2, T4a LNR1, T1LNR5), IIIA (T3LNR3, T2LNR5, T4b LNR1, T4a LNR2, T3LNR4), IIIB (T3LNR5, T4a LNR3, T4a LNR4, T4b LNR2), and IIIC (T4b LNR3, T4a LNR5, T4b LNR4, T4b LNR5) was significantly different ( P <0.05). Decision curve analysis showed that the net income of the new TLNRM staging system for different decision thresholds was higher than the prediction line of the traditional eighth TNM staging system. The smaller Akaike information criterion and Bayesian information suggested that the new staging system had a higher sensitivity for predicting prognosis than the traditional staging system. TLNRM II and III patients benefited from adjuvant chemotherapy, while adjuvant chemotherapy did not improve the prognosis of TNM II patients. These findings were confirmed by the external validation data. CONCLUSION The new TLNRM staging system was superior to the eighth edition AJCC staging system for staging and predicting the prognosis of patients with RSC and may become an effective tool in clinical practice.
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Affiliation(s)
| | | | | | - Dacheng Wen
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, People’s Republic of China
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Quaas A. [Prognostic histological markers in colorectal cancer]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:287-293. [PMID: 37368053 DOI: 10.1007/s00292-023-01206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Colon carcinomas are among the most common malignant tumors worldwide. The critical evaluation of different therapy options is particularly relevant. On the one hand, colon carcinomas more often occur at an older age, on the other hand patients with colon carcinomas often live for decades after initial diagnosis - it is just as important to avoid overtreatment as it is to avoid undertreatment, which shortens the patient's life span. Prognostically effective biomarkers are decision-making tools. There are clinical, molecular, and histological prognostic markers-the latter are presented in this paper. AIM OF THE WORK To present the current state of knowledge on morphologically determinable prognostic markers in colon cancer. MATERIALS AND METHOD Literature search in PubMed and Medline. CONCLUSIONS In their daily work, pathologists identify highly relevant prognostic markers that are essential for therapeutic decisions. These markers must be communicated to the clinical colleague. The most important and longest-known prognostic markers are staging (TNM), including local resection status, lymph node involvement and number on the surgical specimen, vascular invasion, perineural sheath infiltration, and histomorphologic growth pattern determination (e.g., micropapillary colon carcinoma is associated with a very unfavorable prognosis). Recently, tumor budding has been added, which has practical applications especially in endoscopically applied pT1 carcinomas ("malignant polyps").
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Affiliation(s)
- Alexander Quaas
- Institut für Pathologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Su X, Brassard A, Bartolomucci A, Dhoparee‐Doomah I, Qiu Q, Tsering T, Rohanizadeh R, Koufos O, Giannias B, Bourdeau F, Feng L, Messina‐Pacheco J, Leo S, Sangwan V, Quail D, Tankel J, Spicer J, Burnier JV, Bailey SD, Ferri L, Cools‐Lartigue J. Tumour extracellular vesicles induce neutrophil extracellular traps to promote lymph node metastasis. J Extracell Vesicles 2023; 12:e12341. [PMID: 37563798 PMCID: PMC10415595 DOI: 10.1002/jev2.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/15/2023] [Indexed: 08/12/2023] Open
Abstract
Lymph nodes (LNs) are frequently the first sites of metastasis. Currently, the only prognostic LN assessment is determining metastatic status. However, there is evidence suggesting that LN metastasis is facilitated by the formation of a pre-metastatic niche induced by tumour derived extracellular vehicles (EVs). Therefore, it is important to detect and modify the LN environmental changes. Earlier work has demonstrated that neutrophil extracellular traps (NETs) can sequester and promote distant metastasis. Here, we first confirmed that LN NETs are associated with reduced patient survival. Next, we demonstrated that NETs deposition precedes LN metastasis and NETs inhibition diminishes LN metastases in animal models. Furthermore, we discovered that EVs are essential to the formation of LN NETs. Finally, we showed that lymphatic endothelial cells secrete CXCL8/2 in response to EVs inducing NETs formation and the promotion of LN metastasis. Our findings reveal the role of EV-induced NETs in LN metastasis and provide potential immunotherapeutic vulnerabilities that may occur early in the metastatic cascade.
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Affiliation(s)
- Xin Su
- Department of Experimental SurgeryMcGill UniversityMontrealQuebecCanada
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Department of PathologyMcGill UniversityMontrealQuebecCanada
| | - Ariane Brassard
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Department of Microbiology and ImmunologyMcGill UniversityMontrealQuebecCanada
| | - Alexandra Bartolomucci
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Department of PathologyMcGill UniversityMontrealQuebecCanada
| | - Iqraa Dhoparee‐Doomah
- Department of Experimental SurgeryMcGill UniversityMontrealQuebecCanada
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Qian Qiu
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Thupten Tsering
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Department of PathologyMcGill UniversityMontrealQuebecCanada
| | - Ramin Rohanizadeh
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Olivia Koufos
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Betty Giannias
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - France Bourdeau
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Lixuan Feng
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Department of Microbiology and ImmunologyMcGill UniversityMontrealQuebecCanada
| | - Julia Messina‐Pacheco
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Department of PathologyMcGill UniversityMontrealQuebecCanada
| | - Sabrina Leo
- Department of Experimental SurgeryMcGill UniversityMontrealQuebecCanada
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Veena Sangwan
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Daniela Quail
- The Rosalind and Morris Goodman Cancer InstituteMcGill UniversityMontrealQuebecCanada
| | - James Tankel
- Division of Thoracic and Upper Gastrointestinal SurgeryMcGill UniversityMontrealQuebecCanada
| | - Jonathan Spicer
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Division of Thoracic and Upper Gastrointestinal SurgeryMcGill UniversityMontrealQuebecCanada
| | - Julia Valdemarin Burnier
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Department of PathologyMcGill UniversityMontrealQuebecCanada
| | - Swneke Donovan Bailey
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
| | - Lorenzo Ferri
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Division of Thoracic and Upper Gastrointestinal SurgeryMcGill UniversityMontrealQuebecCanada
| | - Jonathan Cools‐Lartigue
- Cancer Research ProgramResearch Institute of McGill University Health CenterMontrealQuebecCanada
- Division of Thoracic and Upper Gastrointestinal SurgeryMcGill UniversityMontrealQuebecCanada
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Liang Z, Xiang D, Feng J, Lyu H, Li Z, Mai G, Yang Q, Wang W, Zhang X. Log odds of positive lymph nodes show better predictive performance on the prognosis of early-onset colorectal cancer. Int J Colorectal Dis 2023; 38:192. [PMID: 37432563 DOI: 10.1007/s00384-023-04490-x] [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] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND As the incidence of colorectal cancer tends to be younger, early-onset colorectal cancer (EOCRC) has attracted more attention in recent years. We aimed to assess the optimal lymph node staging system among EOCRC patients, and then, establish informative assessment models for prognosis prediction. METHODS Data of EOCRC were retrieved from the Surveillance, Epidemiology, and End Results database. Survival prediction ability of three lymph node staging systems including N stage of the tumor node metastasis (TNM) staging system, lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) was assessed and compared using Akaike information criterion (AIC), Harrell's concordance index (C-index), and likelihood ratio (LR) test. Univariate and multivariate Cox regression analyses were conducted to identify the prognostic predictors for overall survival (OS) and cancer-specific survival (CSS). Effectiveness of the model was demonstrated by receiver operative curve and decision curve analysis. RESULTS A total of 17,535 cases were finally included in this study. All three lymph node staging systems showed significant performance in survival prediction (p < 0.001). Comparatively, LODDS presented a better ability of prognosis prediction with lower AIC (OS: 70,510.99; CSS: 60,925.34), higher C-index (OS: 0.6617; CSS: 0.6799), and higher LR test score (OS: 998.65; CSS: 1103.09). Based on independent factors identified from Cox regression analysis, OS and CSS nomograms for EOCRC were established and validated. CONCLUSIONS LODDS shows better predictive performance than N stage or LNR among patients with EOCRC. Novel validated nomograms based on LODDS could effectively provide more prognostic information than the TNM staging system.
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Affiliation(s)
- Zongyu Liang
- Department of Gastrointestinal Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Deyu Xiang
- Department of Gastrointestinal Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Jiahao Feng
- Department of Proctology Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Haina Lyu
- Department of Gastrointestinal Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Zhu Li
- Department of Gastrointestinal Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Guangzhi Mai
- Department of Proctology Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Qingshui Yang
- Department of Gastrointestinal Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Wanchuan Wang
- Department of Proctology Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China
| | - Xiaobin Zhang
- Department of Gastrointestinal Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People's Republic of China.
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Zhan Y, Ni K, Liu Z, Xin R, Han Q, Ping H, Liu Y, Zhao X, Wang W, Yan S, Sun J, Zhang Q, Wang G, Zhang Z, Zhang X, Hu X, Li G, Zhang C. Stage III deficient mismatch repair colon patients get greater benefit from earlier starting oxaliplatin-based chemotherapy regimen. Sci Rep 2023; 13:8969. [PMID: 37268749 DOI: 10.1038/s41598-023-33153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/07/2023] [Indexed: 06/04/2023] Open
Abstract
We evaluate the prognostic value of chemotherapy and other prognostic factors on overall survival among colon patients with deficient mismatch repair (dMMR), and determine the optimum time to start chemotherapy after surgery. Data of 306 colon cancer patients with dMMR who received radical surgery were collected from three Chinese centers between August 2012 and January 2018. Overall survival (OS) was assessed with the Kaplan-Meier method and log-rank. Cox regression analysis were used to assess influencing prognosis factors. The median follow-up time for all patients was 45.0 months (range, 1.0-100). There was a nonsignificant OS benefit from chemotherapy for patients with stage I and stage II disease, including high-risk stage II disease (log-rank p: 0.386, 0.779, 0.921), and a significant OS benefit for patients with stage III and stage IV disease for receiving post-operation chemotherapy (log-rank p = 0.002, 0.019). Stage III patients benefitted from chemotherapy regimens that contained oxaliplatin (log-rank p = 0.004), and Starting chemotherapy with oxaliplatin treatment earlier resulted in better outcomes (95% CI 0.013-0.857; p = 0.035). Chemotherapy regimens containing oxaliplatin can prolong the survival time of stage III and IV dMMR colon cancer patients. This beneficial manifestation was more pronounced after starting chemotherapy treatment early post operation. High risk stage II dMMR colon patients including T4N0M0 cannot benefit from chemotherapy.
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Affiliation(s)
- Yixiang Zhan
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Medicine, Nankai University, Tianjin, China
| | - Kemin Ni
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Medicine, Nankai University, Tianjin, China
| | - Zhaoce Liu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Medicine, Nankai University, Tianjin, China
| | - Ran Xin
- School of Medicine, Nankai University, Tianjin, China
| | - Qiurong Han
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hangyu Ping
- School of Medicine, Nankai University, Tianjin, China
| | - Yaohong Liu
- School of Medicine, Nankai University, Tianjin, China
| | - Xuanzhu Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wanting Wang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Suying Yan
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Sun
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Guihua Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zili Zhang
- The Third Central, Clinical College of Tianjin Medical University, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Xia Hu
- Department of Agriculture Insect, Institute of Plant Protection, Tianjin Academy of Agricultural Sciences, Tianjin, China
| | - Guoxun Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
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