Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Prognostic value of lymph node metastasis in patients with T1-stage colorectal cancer from multiple centers in China
Zhen-Qiang Sun, Shuai Ma, Quan-Bo Zhou, Shuai-Xi Yang, Yuan Chang, Xiang-Yue Zeng, Wei-Guo Ren, Fang-Hai Han, Xiang Xie, Fan-Ye Zeng, Xian-Tao Sun, Gui-Xian Wang, Zhen Li, Zhi-Yong Zhang, Jun-Min Song, Jin-Bo Liu, Wei-Tang Yuan
Zhen-Qiang Sun, Shuai Ma, Quan-Bo Zhou, Shuai-Xi Yang, Yuan Chang, Xian-Tao Sun, Gui-Xian Wang, Zhen Li, Zhi-Yong Zhang, Jun-Min Song, Jin-Bo Liu, Wei-Tang Yuan, Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Zhen-Qiang Sun, Xiang-Yue Zeng, Department of Gastrointestinal Surgery, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Wei-Guo Ren, Department of Gastroenterology, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Fang-Hai Han, Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Xiang Xie, Department of Coronary Artery Disease, Heart Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Fan-Ye Zeng, Department of Oncology, the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Author contributions: Sun ZQ, Ma S and Zhou QB contributed equally to this work; Sun ZQ and Zhou QB designed the study and analyzed the data; Ma S, Yang SX and Chang Y performed the experiments; Ma S wrote the paper; Zeng XY, Ren WG, Han FH, Xie X, Zeng FY, Sun XT, Wang GX, Li Z, Zhang ZY, and Song JM collected the data; Liu JB and Yuan WT designed the study and revised the paper; all authors have read and approved the final version to be published.
Institutional review board statement: All tissues have been approved by the Ethics Review Committee of the First Affiliated Hospital of Zhengzhou University before they were used for research purposes.
Informed consent statement: All patients who provided clinical material signed an informed consent form.
Conflict-of-interest statement: All authors have declared that there is no conflict of interest.
Data sharing statement: No additional data are available for this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Tang Yuan, MD, PhD, Chief physician, Professor, Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou 450052, Henan Province, China.
yuanweitang@zzu.edu.cn
Telephone: +1-51-49341934 Fax: +1-51-48431434
Received: July 20, 2017
Peer-review started: July 21, 2017
First decision: August 30, 2017
Revised: October 21, 2017
Accepted: November 28, 2017
Article in press: November 28, 2017
Published online: December 28, 2017
Processing time: 36 Days and 2.2 Hours
AIM
To explore the features and prognostic value of lymph node metastasis in patients with T1-stage colorectal cancer (CRC).
METHODS
In all, 321 cases of T1-stage CRC were selected from 10132 patients with CRC who received surgical therapy in six large-scale hospitals in China and were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for lymphatic metastasis. A survival analysis was then performed to analyze the prognostic value of lymph node metastasis.
RESULTS
The occurrence rate of T1 stage was 3.17% (321/10132); of these patients, the lymph node metastasis rate was 8.41% (27/321), and the non-lymph node metastasis rate was 91.59% (294/321). Univariate analysis showed that preoperative serum CEA, preoperative serum CA199, preoperative serum CA724, vascular invasion, and degree of differentiation were associated with lymph node metastasis in T1-stage CRC (P < 0.05 for all). Multivariate analysis indicated that preoperative serum CA724, vascular invasion, and degree of differentiation were closely related to lymph node metastasis (P < 0.05 for all). Log-rank survival analysis showed that age, preoperative serum CEA, preoperative serum CA199, vascular invasion, degree of differentiation, and lymph node metastasis (χ2 = 24.180, P < 0.001) were predictors of 5-year overall survival (OS) (P < 0.05 for all). COX regression analysis demonstrated that preoperative serum CA199 and lymph node metastasis (HR = 5.117; P < 0.05; 95%CI: 0.058-0.815) were independent prognostic indicators of 5-year OS in patients with T1-stage CRC (P < 0.05 for both).
CONCLUSION
The morbidity of T1-stage CRC was 3.17% for all CRC cases. Preoperative serum CA724, vascular invasion, and degree of differentiation are independent risk factors for lymph node metastasis. Lymph node metastasis is an independent prognostic factor for OS in patients with T1-stage CRC.
Core tip:The high morbidity of patients with colorectal cancer (CRC) is caused by the likelihood of recurrence and metastasis. This study focused on the features and prognostic value of lymph node metastasis in patients with T1-stage CRC. According to the statistical analysis, we found a very low morbidity in patients with T1-stage CRC. Moreover, our findings confirm that preoperative serum CA724, vascular invasion, and degree of differentiation were independent risk factors for lymph node metastasis, which was demonstrated to be an independent prognostic factor for 5-year OS in patients with T1-stage CRC.
