1
|
Kuo YH, You JF, Hung HY, Chin CC, Chiang JM, Chang CH. Number of negative lymph nodes with a positive impact on survival of stage III colon cancer; a retrospective observation study for right side and left side colon. BMC Cancer 2022; 22:126. [PMID: 35100975 PMCID: PMC8802462 DOI: 10.1186/s12885-021-09154-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background The purpose was to examine the effect of negative lymph nodes (NLN) number on survival in stage III colon cancer. To reduce the interference of acute inflammation, we included patients with stage III colon cancer who had undergone elective surgery and excluded those who had tumor perforation, obstruction, ischemia, or massive tumor bleeding. Methods This retrospective cohort study included 2244 patients with stage III colon cancer between 1995 and 2016 at a single center. The effect of NLN on 5-year relapse-free survival (RFS), 5-year overall survival (OS), and comparison of multivariate factors was assessed according to tumor locations. Results The two optimal cutoff values of NLN for proximal and distal colon, namely 27 and 12, were determined by plotting the time-dependent receiver operating characteristic curve. Overall, 499 of 891 and 1020 of 1353 patients with right-side and left-side colon cancer, respectively, had high NLN. In right-side colon cancer, patients with high NLN (≥ 27) had superior OS (74.9% vs. 62.7%, P < 0.001) and RFS (75.0% vs. 61.9%, P < 0.001) than did those with low NLN. Moreover, in left-side colon cancer, patients with high NLN (≥12) experienced significantly superior OS (80.8% vs. 68.6%, P < 0.001) and RFS (77.3% vs. 66.2%, P < 0.001) than did those with low NLN. Among the different subgroups of stage III colon cancer, the high NLN group showed significantly superior RFS and OS in stage IIIB (RFS: 77.0% vs. 68.0%, P = 0.001; OS: 78.6% vs. 67.9%, P < 0.001) and IIIC (RFS: 58.2% vs. 44.1%, P = 0.001; OS: 65.7% vs. 51.1%, P < 0.001) colon cancer. However, in stage IIIA colon cancer, high NLN only showed survival benefit in OS (91.5% vs. 89.8%, P = 0.041). Multivariate analyses confirmed that high NLN, high carcinoembryonic antigen (≥ 5 ng/mL) level, and stage IIIC status are three independent prognostic factors in both the proximal and distal colon. Conclusions NLN is a crucial prognostic factor for stage III colon cancer in various tumor locations or in the subgroups of stage III disease. In advanced stage III colon cancer, the importance of NLN and its role in anti-cancer immune response could be highlighted.
Collapse
Affiliation(s)
- Yi-Hung Kuo
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Medical Foundation, Chiayi Branch, No. 6, Sec. West, Chia-Pu Road, Putz City, Chiayi Hsien, 613, Taiwan.,Graduate Institute of Clinical Medicine, Chang Gung University, Linkuo, Taiwan
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Medical Foundation, Linkuo, Taiwan
| | - Hsin-Yuan Hung
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Medical Foundation, Linkuo, Taiwan
| | - Chih-Chien Chin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Medical Foundation, Chiayi Branch, No. 6, Sec. West, Chia-Pu Road, Putz City, Chiayi Hsien, 613, Taiwan. .,Graduate Institute of Clinical Medicine, Chang Gung University, Linkuo, Taiwan.
| | - Jy-Ming Chiang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Medical Foundation, Linkuo, Taiwan
| | - Chia-Hao Chang
- Chang Gung University of Science and Technology, Chiayi, Taiwan
| |
Collapse
|
2
|
Forissier V, Tallet A, Cohen M, Classe JM, Reyal F, Chopin N, Mazouni C, Gimbergues P, Daraï E, Colombo PE, Azuar P, Lambaudie E, Houvenaeghel G. Is post-mastectomy radiation therapy contributive in pN0-1mi breast cancer patients? Results of a French multi-centric cohort. Eur J Cancer 2017; 87:47-57. [PMID: 29107861 DOI: 10.1016/j.ejca.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 11/21/2022]
Abstract
AIM To assess the value of post-mastectomy radiation therapy (PMRT) to breast cancer (BC) patients with no or minimal lymph node (LN) involvement. MATERIALS AND METHODS We retrospectively analysed a French multi-centric cohort of 4283 patients treated by mastectomy and axillary dissection, with or without PMRT, between 1980 and 2013. Practices were analysed for three treatment periods (1980-1999, 2000-2005 and 2006-2013). The impact of PMRT on loco-regional recurrence (LRR), disease-free survival (DFS), BC-specific survival and overall survival was assessed in pN0-1mi patients using multivariate analyses (logistic regression and Cox model). It was subsequently assessed based on the number of clinicopathological recurrence-risk factors, generating a prognostic index (French-PMRT index), to isolate a pN0-1mi patients subgroup that might derive a benefit from PMRT. We tested the accuracy of the Cambridge-PMRT (c-PMRT) index to discriminate between patients with significantly different outcomes and the value of PMRT in each c-PMRT prognostic group. RESULTS More than half of the pN0-1mi patients of our cohort underwent PMRT, which almost significantly improved LRR-free survival and DFS. Matching pN0-1mi patients based on the number of clinicopathologic recurrence-risk factors identified a higher risk subpopulation (≥3 recurrence-risk factors), but PMRT did not improve patient outcomes. Although the c-PMRT index had the potential to predict patient outcomes, its use did not help in making the decision of whether or not to use PMRT. CONCLUSION We failed to isolate a subgroup of early BC patients without LN involvement suitable for PMRT, despite studying a large cohort.
Collapse
|
3
|
Li X, Lu H, Xu K, Wang H, Liang X, Hu Z. Negative lymph node count is an independent prognostic factor for patients with rectal cancer who received preoperative radiotherapy. BMC Cancer 2017; 17:227. [PMID: 28351352 PMCID: PMC5370465 DOI: 10.1186/s12885-017-3222-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background Negative lymph node (NLN) count has been reported to provide more accurate prognostic information than the N stage alone in patients with rectal cancer (RC). Since preoperative radiotherapy (Pre-RT) can significantly affect the LN status, it is unclear whether NLN count still has prognostic value count on survival of patients with RC who received Pre-RT. Methods In this study, clinicopathological characteristics, number of positive LNs and survival time were collected from Surveillance, Epidemiology, and End Results Program (SEER)-registered RC patients. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors for survival. Results X-tile plots identified 9 (P < 0.001) as the optimal cutoff NLN value to divide the patients into high and low risk subsets in terms of cause specific survival (CSS). NLN count was validated as independently prognostic factor in univariate and multivariate analysis (P < 0.001). Subgroup analysis showed that NLN count was an independently prognostic factor for patients with stage ypII (P = 0.002) and ypIII (P < 0.001). Conclusions Our results firmly demonstrated that NLN count provides accurate prognostic information for RC patients with Pre-RT.
Collapse
Affiliation(s)
- Xinxing Li
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China
| | - Hao Lu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China
| | - Kai Xu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China
| | - Haolu Wang
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Xiaowen Liang
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.
| | - Zhiqian Hu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China.
| |
Collapse
|
4
|
Wang QX, Cai YF, Chen YY, Zhang W, Jin WX, Chen ED, Zhang XH, Li Q. Additional Prognostic Value of Lymph Node Ratio (LNR) and Number of Negative Lymph Nodes (NLNs) in Chinese Patients with Triple Negative Breast Cancer. Ann Clin Lab Sci 2017; 47:68-75. [PMID: 28249920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study aimed to investigate the prognostic value of lymph node ratio (LNR), number of removed lymph nodes (RLNs), and number of negative lymph nodes (NLNs) in Chinese patients with triple negative breast cancer. METHODS The study cohort comprised 394 breast cancer patients with the triple negative subtype. The log-rank test and Cox proportional hazards analysis was employed to identify prognostic clinicopathological factors. RESULTS The median follow-up time was 61 months, and the five-year disease-free survival (DFS) and overall survival (OS) were 63.75% and 64.97%, respectively. Univariate Cox survival analysis revealed that pN stage, LNR, and NLNs were significant prognostic factors for DFS and OS (all, p<0.05). Multivariate analysis including pN stage and LNR showed that LNR was an independent prognostic factor for DFS (p=0.047) and OS (p=0.0497). When combining pN stage, LNR, and NLNs together, only NLNs was an independent prognostic factor for DFS and OS (p=0.014). LNR is prognostically superior to pN stage in patients with triple negative breast cancer. CONCLUSIONS Our study revealed that LNR and NLNs can provide additional prognostic value for DFS and OS. Moreover, LNR had a better prognostic value compared with pN stage.
Collapse
Affiliation(s)
- Qing-Xuan Wang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ye-Feng Cai
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ying-Ying Chen
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wei Zhang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wen-Xu Jin
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - En-Dong Chen
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiao-Hua Zhang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Quan Li
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| |
Collapse
|
5
|
Wu S, Zhou J, Ren Y, Sun J, Li F, Lin Q, Lin H, He Z. Tumor location is a prognostic factor for survival of Chinese women with T1-2N0M0 breast cancer. Int J Surg 2014; 12:394-8. [PMID: 24657350 DOI: 10.1016/j.ijsu.2014.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/09/2014] [Accepted: 03/17/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of primary tumor location on the survival of Chinese women with T1-2N0M0 breast cancer. METHODS The clinical data of 1044 patients with stage T1-2N0M0 breast cancer who were treated from 1999 to 2007 were retrospectively analyzed. Patients were divided according to the primary tumor location: upper-outer quadrant (UOQ), upper-inner quadrant (UIQ), lower-outer quadrant (LOQ), lower-inner quadrant (LIQ), and nipple and central breast (central). The effect of primary tumor location on recurrence-free survival (RFS) and overall survival (OS) were determined. RESULTS The median age at diagnosis was 47 years. The tumor was located in the UOQ in 524 patients (50.2%), the LOQ in 124 (11.9%), the UIQ in 229 (21.9%), the LIQ in 59 (5.7%), and centrally in 108 patients (10.3%). The 5- and 10-year RFS and OS of the LIQ group were significantly poorer than that of patients in the other groups (RFS: 72.1% vs. 82.2-86.7%, P = 0.041; OS: 73.6% vs. 85.3-89.1%, P = 0.024). Multivariate Cox analysis showed that primary tumor location in the LIQ was an independent prognostic factor for RFS (hazard ratio [HR] = 2.977; 95% confidence interval [CI] 1.219-7.273; P = 0.017) and OS (HR = 2.949; 95% CI 1.207-7.208; P = 0.018). CONCLUSION Primary tumor location is an important prognostic factor for survival of Chinese women with T1-2N0M0 breast cancer.
Collapse
Affiliation(s)
- Sangang Wu
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Juan Zhou
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Yufeng Ren
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510060, China
| | - Jiayuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Fengyan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Qin Lin
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Huanxin Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhenyu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| |
Collapse
|