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Wilkie BD, Chan JM, Paratz E, Proud D, Smart P, An V. Lymph Node Yield and Colorectal Cancer Survival: A Bowel Cancer Outcomes Registry Cohort Study. ANZ J Surg 2025. [PMID: 40265735 DOI: 10.1111/ans.70150] [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: 03/06/2024] [Revised: 03/23/2025] [Accepted: 04/07/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND The current standard for lymph node (LN) sampling in colorectal cancer (CRC) surgery is a minimum of 12 LNs. Emerging evidence suggests higher LN yields may improve disease-free survival (DFS); however, an "optimal" number of LNs has yet to be definitively established. The aim of this study was to correlate LN yield with survival outcomes in patients undergoing surgery for nonmetastatic CRC. METHODS The Bowel Cancer Outcomes Registry (BCOR) is a clinical quality registry in Australia and New Zealand. Post-operative patients aged ≥ 18 years with histologically confirmed CRC, nonmetastatic disease at diagnosis and with follow-up status documented were included. Post-operative outcomes and survival were assessed with logistic regression. The primary endpoint was CRC-specific mortality. Secondary endpoints were CRC recurrence and all-cause mortality. RESULTS Of 91 271 patient episodes, 10 616 individual eligible patients were identified (45.4% male, n = 4828). The median number of LNs resected was 18 [quartiles 0-12, 13-17, 18-23 and > 23]. A significant difference in CRC-specific mortality was seen between quartiles (p = 0.023), with the primary significant difference demonstrated between the lowest quartile (≤ 12 LNs) and other groups. On long-term follow-up, CRC recurrence and CRC-specific mortality were higher in the group with ≤ 12 LNs resected (16.0% vs. 14.0%, adjusted p = 0.049 and 4.5% vs. 3.3%, adjusted p = 0.037 respectively). CONCLUSION This study supports the current consensus that > 12 LNs are required for adequate staging and oncological clearance in CRC surgery, and demonstrates yields ≤ 12 LNs are associated with higher CRC recurrence and mortality.
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Affiliation(s)
- Bruce D Wilkie
- Department of Surgery, Eastern Health, Box Hill, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - James M Chan
- Department of Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Elizabeth Paratz
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David Proud
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Philip Smart
- Department of Surgery, Eastern Health, Box Hill, Victoria, Australia
- Department of General Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Vinna An
- Department of Surgery, Eastern Health, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Wang L, Liu SS. Does lymph node dissection improve the prognosis of patients with colorectal cancer? World J Gastrointest Surg 2024; 16:3895-3898. [PMID: 39734447 PMCID: PMC11650252 DOI: 10.4240/wjgs.v16.i12.3895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/28/2024] [Accepted: 10/31/2024] [Indexed: 11/27/2024] Open
Abstract
The number of lymph nodes (LNs) dissected during surgery has become an interesting topic. Simple intuition always leads us to believe that dissecting more LNs will result in more accurate pathological staging and assurance of surgical quality. However, when the number of LNs dissected reaches a certain threshold, the patient's prognosis does not continue to improve as the number of dissected nodes increases. Instead, an increase in the number of dissected LNs may be accompanied by a higher incidence of complications. Currently, there are only less than 40% of colorectal cancer patients undergoing adequate LN evaluation. Therefore, obtaining a sufficient number of LNs in clinical practice is extremely challenging. How to further address the insufficiency of LN dissection due to various reasons, which results in concerns of surgeons about patient prognosis, is currently a critical focus.
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Affiliation(s)
- Liang Wang
- Department of Gastrointestinal Oncology Surgery, The Affiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China
| | - Shan-Shan Liu
- Graduate School of Qinghai University, The Affiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China
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Men V, Bahl P, Jin JZ, Singh PP, Hill AG. Lymph Node Yield and Long-Term Mortality Risk in Patients with Colon Cancer: A 20-Year Follow-Up National Study. Ann Surg Oncol 2024:10.1245/s10434-024-16428-w. [PMID: 39496903 DOI: 10.1245/s10434-024-16428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 10/12/2024] [Indexed: 11/06/2024]
Abstract
BACKGROUND Lymph node status is a well-established prognostic factor for colon cancer, but the optimal number of nodes for accurate staging remains unclear. This study explored the relationship between lymph node yield (LNY) and 5-year mortality rates in colon cancer patients in New Zealand. METHODS Data from the New Zealand Cancer Registry were retrospectively analyzed for patients with TNM stage I, II, and III colon cancer between August 2003 and December 2021, with follow-up until January 2024. The primary outcome was the 5-year all-cause mortality rate, with LNY, age, sex, ethnicity, tumor site, district health board (DHB), and the number of positive nodes as covariates. Statistical analyses included univariate analysis, Cox regression modeling, and chi-squared tests. RESULTS LNY was a significant predictor of 5-year mortality risk (hazard ratio 0.985, p < 0.0001), adjusted for age, sex, ethnicity, tumor site, and DHB. The strongest association between LNY and mortality rate was observed at 12 nodes. Further increases in LNY beyond 22 nodes did not lead to statistically significant differences in mortality rates. Lymph node ratio (LNR) was strongly associated with survival in stage III colon cancer, independent of LNY and the number of positive nodes. CONCLUSIONS Higher LNY is significantly associated with reduced 5-year mortality rates in stage I-III colon cancer up to the 22-node mark. The strong correlation between LNR and mortality highlights its potential value for improving treatment planning in future clinical practice.
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Affiliation(s)
- Velia Men
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Praharsh Bahl
- South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - James Z Jin
- South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Primal Parry Singh
- South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
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Zhang Y, Tang Y, Ma H, Su H, Xu Z, Gao C, Zhou H, Jin J. Number of lymph nodes retrieved in patients with locally advanced rectal cancer after total neoadjuvant therapy: post-hoc analysis from the STELLAR trial. BJS Open 2024; 8:zrae118. [PMID: 39382122 PMCID: PMC11462327 DOI: 10.1093/bjsopen/zrae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/25/2024] [Accepted: 08/17/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND The current gold standard for extraperitoneal locally advanced rectal cancer is total neoadjuvant therapy (TNT) followed by total mesorectal excision. This research explored the number of lymph nodes in patients with locally advanced rectal cancer after TNT and its correlation with survival. MATERIALS AND METHODS This is a post-hoc analysis based on the STELLAR trial, including patients with locally advanced rectal cancer from 16 tertiary centres who were randomized for short-term radiotherapy followed by chemotherapy (TNT group) or long-term concurrent chemotherapy group followed by total mesorectal excision between 2015 and 2018. This lymph node-related analysis is based on the TNT group. Subgroups were differentiated based on the lymph node harvest (below the median number: limited lymphadenectomy group, and greater than/equal to the median number: extended lymphadenectomy group). The primary outcomes were overall survival and disease-free survival (DFS). Correlations with clinical/pathological variables, lymphadenectomy categories and use of adjuvant chemotherapy were explored. RESULTS Among the 451 patients enrolled in the STELLAR trial, 227 patients (50.3%) were assigned to the TNT group, including 29.5% females. The median number of lymph nodes retrieved in the TNT group was 11.0. Patients in the limited lymphadenectomy subgroup exhibited worse overall survival than those with extended lymphadenectomy (HR 2.95 (95% c.i. 1.47 to 5.92), P = 0.001). The overall survival was similar in the ypN0-limited and ypN1-extended subgroups (HR 0.38 (95% c.i. 0.11 to 1.30), P = 0.109). Adjuvant chemotherapy was associated with better overall survival and DFS than no adjuvant chemotherapy overall (P < 0.001) and in the limited lymphadenectomy subgroup (P < 0.001). However, there was no significant difference in overall survival or DFS with or without adjuvant chemotherapy in the extended lymphadenectomy subgroup (P = 0.887 and P = 0.192, respectively). CONCLUSION In the STELLAR trial, the median number of lymph nodes harvested was 11. In patients with limited lymphadenectomy, the use of adjuvant therapy after TNT was beneficial and correlated with better prognosis compared with patients who did not receive adjuvant chemotherapy.
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Affiliation(s)
- Yueyang Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huiying Ma
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Su
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Zheng Xu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changyuan Gao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Jin
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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He F, Qu SP, Yuan Y, Qian K. Lymph node dissection does not affect the survival of patients with tumor node metastasis stages I and II colorectal cancer. World J Gastrointest Surg 2024; 16:2503-2510. [PMID: 39220053 PMCID: PMC11362951 DOI: 10.4240/wjgs.v16.i8.2503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The effect of the number of lymph node dissections (LNDs) during radical resection for colorectal cancer (CRC) on overall survival (OS) remains controversial. AIM To investigate the association between the number of LNDs and OS in patients with tumor node metastasis (TNM) stage I-II CRC undergoing radical resection. METHODS Patients who underwent radical resection for CRC at a single-center hospital between January 2011 and December 2021 were retrospectively analyzed. Cox regression analyses were performed to identify the independent predictors of OS at different T stages. RESULTS A total of 2850 patients who underwent laparoscopic radical resection for CRC were enrolled. At stage T1, age [P < 0.01, hazard ratio (HR) = 1.075, 95% confidence interval (CI): 1.019-1.134] and tumour size (P = 0.021, HR = 3.635, 95%CI: 1.210-10.917) were independent risk factors for OS. At stage T2, age (P < 0.01, HR = 1.064, 95%CI: 1.032-1.098) and overall complications (P = 0.012, HR = 2.297, 95%CI: 1.200-4.397) were independent risk factors for OS. At stage T3, only age (P < 0.01, HR = 1.047, 95%CI: 1.027-1.066) was an independent risk factor for OS. At stage T4, age (P < 0.01, HR = 1.057, 95%CI: 1.039-1.075) and body mass index (P = 0. 034, HR = 0.941, 95%CI: 0.890-0.995) were independent risk factors for OS. However, there was no association between LNDs and OS in stages I and II. CONCLUSION The number of LDNs did not affect the survival of patients with TNM stages I and II CRC. Therefore, insufficient LNDs should not be a cause for alarm during the surgery.
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Affiliation(s)
- Fan He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shu-Pei Qu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ye Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Wei R, Zheng Z, Li Q, Qian Y, Wu C, Li Y, Wang M, Chen J, He W. Prognostic and predictive value of examined lymph node count in stage III colorectal cancer: a population based study. World J Surg Oncol 2024; 22:155. [PMID: 38872183 PMCID: PMC11170906 DOI: 10.1186/s12957-024-03404-7] [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: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The role of tumor-draining lymph nodes in the progression of malignant tumors, including stage III colorectal cancer (CRC), is critical. However, the prognostic and predictive value of the number of examined lymph nodes (ELNs) are not fully understood. METHODS This population-based study retrospectively analyzed data from 106,843 patients with stage III CRC who underwent surgical treatment and registered in three databases from 2004 to 2021. The Surveillance, Epidemiology, and End Results (SEER) cohort was divided using into training and test cohorts at a ratio of 3:2. We employed restricted cubic spline (RCS) curves to explore nonlinear relationships between overall survival (OS) and ELNs counts and performed Cox regression to evaluate hazard ratios across different ELNs count subtypes. Additional validation cohorts were utilized from the First Affiliated Hospital, Sun Yat-sen University and The Cancer Genome Atlas (TCGA) under the same criteria. Outcomes measured included OS, cancer-specific survival (CSS), and progression-free survival (PFS). Molecular analyses involved differential gene expression using the "limma" package and immune profiling through CIBERSORT. Tissue microarray slides and multiplex immunofluorescence (MIF) were used to assess protein expression and immune cell infiltration. RESULTS Patients with higher ELNs counts (≥ 17) demonstrated significantly better long-term survival outcomes across all cohorts. Enhanced OS, CSS, and PFS were notably evident in the LN-ELN group compared to those with fewer ELNs. Cox regression models underscored the prognostic value of higher ELNs counts across different patient subgroups by age, sex, tumor differentiation, and TNM stages. Subtype analysis based on ELNs count revealed a marked survival benefit in patients treated with adjuvant chemotherapy in the medium and large ELNs counts (≥ 12), whereas those with fewer ELNs showed negligible benefits. RNA sequencing and MIF indicated elevated immune activation in the LN-ELN group, characterized by increased CD3+, CD4+, and CD8 + T cells within the tumor microenvironment. CONCLUSIONS The number of ELNs independently predicts survival and the immunological landscape at the tumor site in stage III CRC, underscoring its dual prognostic and predictive value.
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Affiliation(s)
- Ran Wei
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Zifan Zheng
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Qinghai Li
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Yan Qian
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Chong Wu
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Yin Li
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
| | - Mian Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
| | - Jianhui Chen
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
- Department of General Surgery, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Nanning, China.
| | - Weiling He
- Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
- Department of Gastrointestinal Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, 361000, China.
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Song J, Kataoka K, Inoue M, Yamada T, Shiozawa M, Beppu N, Kuriyama S, Suto T, Matsuhashi N, Sakura Y, Kanazawa A, Kagawa H, Kanemitsu Y, Ceelen W, Ikeda M. Lymphatic spread patterns in young versus elderly patients with stage III colon cancer. BJS Open 2024; 8:zrae036. [PMID: 38818960 PMCID: PMC11140818 DOI: 10.1093/bjsopen/zrae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The anatomical pattern of lymph nodes spread differs between young (aged 45 years or younger) and elderly (aged 80 years or older) patients with stage III colon cancer and is poorly investigated. METHODS Two groups of patients (young and elderly) with stage III colon cancer who underwent upfront extensive (D3) lymphadenectomy at eight Japanese centres between 1998 and 2018 were retrospectively analysed. The primary endpoint was the proportion of positive central lymph nodes. The lymph nodes spreading pattern and its prognostic impact on recurrence-free survival and overall survival in the two groups were also compared. RESULTS Two hundred and ten young patients and 348 elderly patients were identified and compared. The total number of lymph nodes harvested and the total number of invaded lymph nodes were significantly higher in younger patients compared with elderly patients (median of 31.5 (3-151) versus 21 (3-116), P < 0.001 and median of 3 (1-21) versus 2 (1-25), P < 0.001 respectively). The proportion of positive central lymph nodes were higher in younger patients than in elderly patients (9.52% (95% c.i. 6.24 to 14.2%) versus 4.59% (95% c.i. 2.84 to 7.31%), P = 0.012). In multivariate models for recurrence-free survival, central lymph nodes invasion were identified as a poor prognostic factor in younger patients (HR 5.21 (95% c.i. 1.76 to 15.39)) but not in elderly patients (HR 1.73 (95% c.i. 0.80 to 3.76)). CONCLUSION Young patients with stage III colon cancer have a higher risk of central lymph nodes invasion, suggesting a more aggressive disease biology. The presence of central lymph nodes invasion are associated with a worse outcome in young patients.
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Affiliation(s)
- Jihyung Song
- Division of Lower GI, Department of Gastroenterological Surgery, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Kozo Kataoka
- Division of Lower GI, Department of Gastroenterological Surgery, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Manabu Inoue
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Naohito Beppu
- Division of Lower GI, Department of Gastroenterological Surgery, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Takeshi Suto
- Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery/Pediatric Surgery, Gifu University, Gifu, Japan
| | - Yusuke Sakura
- Department of Gastrointestinal Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Akiyoshi Kanazawa
- Department of Gastrointestinal Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shunto-gun, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Masataka Ikeda
- Division of Lower GI, Department of Gastroenterological Surgery, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
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Qiao Y, Zhu J, Han T, Jiang X, Wang K, Chen R, Du Y, Li J, Sun L. Finding the minimum number of retrieved lymph nodes in node-negative colorectal cancer using Real-world Data and the SEER database. Int J Surg 2023; 109:4173-4184. [PMID: 37755374 PMCID: PMC10720778 DOI: 10.1097/js9.0000000000000746] [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: 04/19/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Current clinical guidelines recommend the removal of at least 12 lymph nodes (LNs) in resectable colorectal cancer (CRC). With advancements in lymphadenectomy technologies, the number of retrieved lymph nodes (rLNs) has markedly increased. This study aimed to investigate the lowest number of rLNs in node-negative patients. MATERIALS AND METHODS A total of 1103 N0 and 208 N1a stage patients were enrolled in our cohort, while 8503 N0 and 1276 N1a patients from the Surveillance, Epidemiology, and End Results CRC database were included. Propensity score matching and multivariate Cox regression analyses were performed to mitigate the influence of selection bias and control for potential confounding variables. RESULTS The median number of rLNs in N0 patients increased from 13.5 (interquartile range [IQR]: 9-18) in 2013 to 17 (IQR: 15-20) in 2019. The restrictive cubic spline illustrated a nonlinear relationship between rLNs and prognosis (nonlinearity, P =0.009), with a threshold ( N =16) influencing clinical outcomes. Patients at either N0 or N1a stage with sufficient rLNs (≥16) demonstrated superior prognoses to those with a limited rLNs (<16). After adjusting for clinical confounders, similar prognoses were observed in N0 limited and N1a adequate populations. Furthermore, Kaplan-Meier curves revealed that N0 limited patients who received chemotherapy exhibited better outcomes than those who did not. CONCLUSIONS Among patients with node-negative CRC, it is crucial to remove 16 or more LNs effectively. Fewer than 16 rLNs should be regarded as an independent risk factor, implying the need for adjuvant chemotherapy.
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Affiliation(s)
- Yihuan Qiao
- Department of Digestive Surgery, Honghui Hospital, Xi’an Jiaotong University
| | - Jun Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of General Surgery, The Southern Theater Air Force Hospital, Guangzhou, People’s Republic of China
| | - Tenghui Han
- Department of Neurology, Airborne Army Hospital, Wuhan
| | - Xunliang Jiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Ke Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Rujie Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Yongtao Du
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Jipeng Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
| | - Li Sun
- Department of Digestive Surgery, Honghui Hospital, Xi’an Jiaotong University
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Zeng H, Chen Y, Lan Q, Lu G, Chen D, Li F, Xu D, Lin S. Association of hemicolectomy with survival in stage II colorectal cancer: a retrospective cohort study. Updates Surg 2023; 75:2211-2223. [PMID: 38001388 DOI: 10.1007/s13304-023-01646-w] [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: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 11/26/2023]
Abstract
To compare the oncological survival outcomes of partial colectomy (PC) and hemicolectomy (HC) in patients with stage II colon cancer. A total of 18,795 patients with stage II colon cancer who underwent hemicolectomy (n = 12,022) or partial colectomy (n = 6773) from 2010 to 2019 were included in the the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were compared between the two groups, and the threshold of harvested lymph nodes was determined. The results showed that age, gender, race, tumor site, scope of regional lymph nodes, postoperative chemotherapy, postoperative radiotherapy, harvested lymph nodes, and tumor size were significantly different between the PC and HC groups (all P < 0.05). The OS rate was slightly lower in hemicolectomy patients than in partial colectomy patients (69.9% vs. 74.5%, respectively, P < 0.001), but CSS was similar between the two groups (87.9% vs. 88.1%, respectively, P = 0.32). After propensity score matching (PSM) was performed, the OS and CSS rates in the two groups were significantly different (CSS 84.3% vs. 88.0%, P < 0.001; OS 62.2% vs. 72.5%, P < 0.001). The survminer R package determined that the optimum threshold for the harvested lymph node count in stage II colon cancer patients was 16. CSS was significantly different between patients with ≥ 12 lymph nodes harvested and patients with ≥ 16 lymph nodes harvested (P = 0.043). Univariate and multivariate Cox regression and survival analyses of stage II colon cancer patients showed that the survival benefit of stage II colon cancer patients receiving partial colectomy was superior to that of patients receiving hemicolectomy. Partial colectomy has significant oncological benefits over hemicolectomy in the treatment of stage II colon cancer patients, even in the case of pT4b or tumor deposits. Removal of 16 lymph nodes during colectomy for stage II colon cancer correlated with improved survival, and this threshold was more effective than the standard threshold of 12 lymph nodes in distinguishing between patients with good and poor prognoses.
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Affiliation(s)
- Hao Zeng
- Fujian Medical University, Fuzhou, China
| | - Yongtai Chen
- Department of Hepatobiliary Pancreatic Abdominal Wall Hernia Surgery, Longyan First Hospital, Fujian Medical University, Longyan, China
| | - Qilong Lan
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, 364000, Longyan, China
| | - Geng Lu
- Department of Hepatobiliary Pancreatic Abdominal Wall Hernia Surgery, Longyan First Hospital, Fujian Medical University, Longyan, China
| | - Dongbo Chen
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, 364000, Longyan, China
| | - Fudi Li
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, 364000, Longyan, China
| | - Dongbo Xu
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, 364000, Longyan, China
| | - Shuangming Lin
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, 364000, Longyan, China.
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Webber AA, Gupta P, Marcello PW, Stain SC, Abelson JS. Lymph node retrieval colon cancer: Are we making the grade? Am J Surg 2023; 226:477-484. [PMID: 37349222 DOI: 10.1016/j.amjsurg.2023.05.035] [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: 03/01/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Adequate lymph node (LN) excision is imperative for pathologic staging and determination of adjuvant treatment. METHODS he 2004-2017 National Cancer Database (NCDB) was queried for curative colon cancer resections. Tumors were categorized by location: left, right, and transverse colon cancers. Adequate (12-20 LNs) vs. inadequate (<12 LNs) lymphadenectomy was examined and sub-analysis of <12 LNs, 12-20 LNs or >20 LNs. Primary outcome was predictors of inadequate lymph node retrieval. RESULTS Of 101,551 patients, 11.2% (11,439) had inadequate lymphadenectomy. The inadequate lymphadenectomy rate steadily decreased. On multivariable analysis, inadequate LN retrieval was associated with transverse (OR 1.49, CI [1.30-1.71]) and left colon cancers (OR 2.66, CI [2.42-2.93], whereas income >$63,333 had decreased likelihood of inadequate LN retrieval (OR 0.68, CI[0.56-0.82]. CONCLUSION We are making the grade as NCDB data demonstrates a steady decrease in inadequate lymphadenectomy (2004-2017). There remain socioeconomic risk factors for inadequate lymphadenectomy that need to be addressed.
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Affiliation(s)
- Alexis A Webber
- The Department is the Department of Colon and Rectal Surgery at Lahey Hospital and Medical Center, United States
| | - Piyush Gupta
- The Department is the Department of Colon and Rectal Surgery at Lahey Hospital and Medical Center, United States
| | - Peter W Marcello
- The Department is the Department of Colon and Rectal Surgery at Lahey Hospital and Medical Center, United States
| | - Steven C Stain
- The Department is the Department of Colon and Rectal Surgery at Lahey Hospital and Medical Center, United States
| | - Jonathan S Abelson
- The Department is the Department of Colon and Rectal Surgery at Lahey Hospital and Medical Center, United States.
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11
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Lee SH, Pankaj A, Neyaz A, Ono Y, Rickelt S, Ferrone C, Ting D, Patil DT, Yilmaz O, Berger D, Deshpande V, Yılmaz O. Immune microenvironment and lymph node yield in colorectal cancer. Br J Cancer 2023; 129:917-924. [PMID: 37507544 PMCID: PMC10491581 DOI: 10.1038/s41416-023-02372-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Lymph node (LN) harvesting is associated with outcomes in colonic cancer. We sought to interrogate whether a distinctive immune milieu of the primary tumour is associated with LN yield. METHODS A total of 926 treatment-naive patients with colorectal adenocarcinoma with more than 12 LNs (LN-high) were compared with patients with 12 or fewer LNs (LN-low). We performed immunohistochemistry and quantification on tissue microarrays for HLA class I/II proteins, beta-2-microglobulin (B2MG), CD8, CD163, LAG3, PD-L1, FoxP3, and BRAF V600E. RESULTS The LN-high group was comprised of younger patients, longer resections, larger tumours, right-sided location, and tumours with deficient mismatch repair (dMMR). The tumour microenvironment showed higher CD8+ cells infiltration and B2MG expression on tumour cells in the LN-high group compared to the LN-low group. The estimated mean disease-specific survival was higher in the LN-high group than LN-low group. On multivariate analysis for prognosis, LN yield, CD8+ cells, extramural venous invasion, perineural invasion, and AJCC stage were independent prognostic factors. CONCLUSION Our findings corroborate that higher LN yield is associated with a survival benefit. LN yield is associated with an immune high microenvironment, suggesting that tumour immune milieu influences the LN yield.
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Affiliation(s)
- Soo Hyun Lee
- Department of Pathology, Boston Medical Center, Boston, MA, USA
| | - Amaya Pankaj
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Azfar Neyaz
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Yuho Ono
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steffen Rickelt
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David Ting
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Deepa T Patil
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Omer Yilmaz
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Berger
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Vikram Deshpande
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Osman Yılmaz
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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12
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Lygre KB, Eide GE, Forsmo HM, Dicko A, Storli KE, Pfeffer F. Complications after open and laparoscopic right-sided colectomy with central lymphadenectomy for colon cancer: randomized controlled trial. BJS Open 2023; 7:zrad074. [PMID: 37643373 PMCID: PMC10465081 DOI: 10.1093/bjsopen/zrad074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A central lymphadenectomy in right-sided colon cancer involves dissection along the superior mesenteric axis, but the extent is debated due to a lack of consensus and the fear of major complications. This randomized controlled trial compared the rate of postoperative morbidity in patients undergoing laparoscopic versus open right-sided colectomy with central lymphadenectomy. METHODS This open, prospective, randomized controlled trial compared patients operated on with open and laparoscopic right-sided colectomy (cStages I-III) with a central lymphadenectomy at two Norwegian institutions between October 2016 and December 2021. Dissections were conducted along the superior mesenteric vein in the laparoscopic group, and along the left anterior border of the superior mesenteric artery in the open group, both according to complete mesocolic excision principles. Surgery was standardized and performed by three experienced surgeons for each study group. The primary outcome of interest was to measure postoperative 30-day complications (Clavien-Dindo ≥ grade II). RESULTS Of 273 eligible patients, 135 were randomized and 128 analysed (63 operated on with open and 65 using laparoscopic procedures). Postoperative complications occurred in 42.8 per cent of the patients treated with open and 38.4 per cent of the patients treated using laparoscopic surgery, P = 0.372. The incidence of Clavien-Dindo grade IIIb complications was 7.9 per cent in the open versus 4.6 per cent in the laparoscopic group, P = 0.341. There were no grade IV or V complications, and no re-operations due to anastomotic leakages. There was no significant difference in the mean(s.e.m.) number of removed lymph nodes (open versus laparoscopic respectively: 31.9(1.8) versus 29.3(1.3); P = 0.235). CONCLUSION There was no significant difference in complications between the two groups. Standardized oncologic right-sided colectomy with central lymphadenectomy along the mesenterial root was performed safely, both open and laparoscopic, with incidence of major complications ranging between 4.6 and 7.9 per cent and no re-operations for anastomotic leakage. Radicality in terms of lymphadenectomy was comparable between the two groups.Registration number: NCT03776591 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Kristin B Lygre
- Department of Gastrointestinal Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir E Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Havard M Forsmo
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Aly Dicko
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kristian E Storli
- Department of Gastrointestinal Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frank Pfeffer
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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13
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Okamoto N, Al-Difaie Z, Scheepers MHMC, Heuvelings DJI, Rodríguez-Luna MR, Marescaux J, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous, Multi-Channel, Near-Infrared Fluorescence Visualization of Mesenteric Lymph Nodes Using Indocyanine Green and Methylene Blue: A Demonstration in a Porcine Model. Diagnostics (Basel) 2023; 13:1469. [PMID: 37189570 PMCID: PMC10137483 DOI: 10.3390/diagnostics13081469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Near-infrared fluorescence (NIRF) image-guided surgery is a useful tool that can help reduce perioperative complications and improve tissue recognition. Indocyanine green (ICG) dye is the most frequently used in clinical studies. ICG NIRF imaging has been used for lymph node identification. However, there are still many challenges in lymph node identification by ICG. There is increasing evidence that methylene blue (MB), another clinically applicable fluorescent dye, can also be useful in the intraoperative fluorescence-guided identification of structures and tissues. We hypothesized that MB NIRF imaging could be used for lymph node identification. The aim of this study was to evaluate the feasibility of intraoperative lymph node fluorescence detection using intravenously (IV) administered MB and compare it to ICG via a camera that has two dedicated near-infrared (NIR) channels. Three pigs were used in this study. ICG (0.2 mg/kg) was administered via a peripheral venous catheter followed by immediate administration of MB (0.25 mg/kg). NIRF images were acquired as video recordings at different time points (every 10 min) over an hour using the QUEST SPECTRUM® 3 system (Quest Medical Imaging, Middenmeer, The Netherlands), which has two dedicated NIR channels for simultaneous intraoperative fluorescence guidance. The 800 nm channel was used to capture ICG fluorescence and the 700 nm channel was used for MB. The target (lymph nodes and small bowel) and the background (vessels-free field of the mesentery) were highlighted as the regions of interest (ROIs), and corresponding fluorescence intensities (FI) from these ROIs were measured. The target-to-background ratio (TBR) was then computed as the mean FI of the target minus the mean FI of the background divided by the mean FI of the background. In all included animals, a clear identification of lymph nodes was achieved at all time points. The mean TBR of ICG in lymph nodes and small bowel was 4.57 ± 1.00 and 4.37 ± 1.70, respectively for the overall experimental time. Regarding MB, the mean TBR in lymph nodes and small bowel was 4.60 ± 0.92 and 3.27 ± 0.62, respectively. The Mann-Whitney U test of the lymph node TBR/small bowel TBR showed that the TBR ratio of MB was statistically significantly higher than ICG. The fluorescence optical imaging technology used allows for double-wavelength assessment. This feasibility study proves that lymph nodes can be discriminated using two different fluorophores (MB and ICG) with different wavelengths. The results suggest that MB has a promising potential to be used to detect lymphatic tissue during image-guided surgery. Further preclinical trials are needed before clinical translation.
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Affiliation(s)
- Nariaki Okamoto
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Danique J. I. Heuvelings
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - María Rita Rodríguez-Luna
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Laurents P. S. Stassen
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
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14
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Ahmad NZ, Azam M, Fraser CN, Coffey JC. A systematic review and meta-analysis of the use of methylene blue to improve the lymph node harvest in rectal cancer surgery. Tech Coloproctol 2023; 27:361-371. [PMID: 36933141 DOI: 10.1007/s10151-023-02779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Methylene blue staining of the resected specimen has been described as an alternative to the conventional palpation and visual inspection method to improve lymph node harvest. This meta-analysis evaluates the usefulness of this technique in surgery for rectal cancer, particularly after neoadjuvant therapy. METHODS Randomized controlled trials (RCTs) comparing lymph node harvest in methylene blue-stained rectal specimens to those of unstained specimens were identified from the Medline, Embase, and Cochrane databases. Non-randomized studies and those with only colonic resections were excluded. The quality of RCTs was assessed using Cochrane's risk of bias tool. A weighted mean difference (WMD) was calculated for overall harvest, harvest after neoadjuvant therapy, and metastatic nodal yield. In contrast, the risk difference (RD) was calculated to compare yields of less than 12 lymph nodes between the stained and unstained specimens. RESULTS Study selection comprised seven RCTs with 343 patients in the unstained group and 337 in the stained group. Overall lymph node harvest and harvest after neoadjuvant therapy were significantly higher in stained specimens with a WMD of 13.4 and 10.6 and a 95% confidence interval (CI) of 9.5-17.2 and 4.8-16.3, respectively. Harvest of metastatic lymph nodes was significantly higher in the stained group (WMD 1.0, 95% CI 0.6-1.4). The yield of less than 12 lymph nodes was significantly higher in the unstained group with RD of 0.292 and 95% CI of 0.182-0.403. CONCLUSION Despite a small number of patients, this meta-analysis confirms improved lymph node harvest in surgical specimens stained with methylene blue compared with unstained specimens.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of Surgery, University Hospital Limerick, St Nessan's Road, Co. Limerick, V94 F858, Dooradoyle, Republic of Ireland.
| | - Muhammad Azam
- Department of Surgery, Southport and Formby District General Hospital, Southport, PR8 6PN, UK
| | - Candice Neezeth Fraser
- Department of Surgery, University Hospital Limerick, St Nessan's Road, Co. Limerick, V94 F858, Dooradoyle, Republic of Ireland
| | - John Calvin Coffey
- Department of Surgery, University Hospital Limerick, St Nessan's Road, Co. Limerick, V94 F858, Dooradoyle, Republic of Ireland
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15
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Hu X, Jiang L, Wu J, Mao W. Prognostic value of log odds of positive lymph nodes, lymph node ratio, and N stage in patients with colorectal signet ring cell carcinoma: A retrospective cohort study. Front Surg 2023; 9:1019454. [PMID: 36684239 PMCID: PMC9849566 DOI: 10.3389/fsurg.2022.1019454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023] Open
Abstract
Aim Little attention has been paid in the prognosis of colorectal signet ring cell carcinoma (SRCC). This study aims to explore the predictive capacity of log odds of positive lymph nodes (LODDS), lymph node ratio (LNR), and pN stage in the prognosis of patients with colorectal SRCC. Methods A retrospective cohort study was designed, and data were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Data on demographic characteristics, clinicopathological features, and treatment were extracted. Outcomes were overall survival (OS) and cancer-specific survival (CSS). Association of LODDS, LNR, and pN stage with OS and CSS were explored using Cox proportional hazard model and Cox competing risk model, respectively, with results showing as hazard ratio and 95% confidence interval (CI). Predictive performance of LODDS, LNR, and pN stage in OS and CSS was assessed by calculating C-index. Results A total of 2,198 patients were included in this study. LODDS, LNR, and pN stage were associated with the OS and CSS of colorectal SRCC patients (all P < 0.05). LODDS showed a good performance in the OS (C-index: 0.704, 95% CI: 0.690-0.718), which was superior to LNR (C-index: 0.657, 95% CI: 0.643-0.671) and pN stage (C-index: 0.643, 95% CI: 0.629-0.657). The C-index of LODDS, LNR, and pN stage for CSS was 0.733 (95% CI: 0.719-0.747), 0.713 (95% CI: 0.697-0.729), and 0.667 (95% CI: 0.651-0.683), respectively. Conclusions LODDS displayed a better predictive capacity in the OS and CSS than LNR and pN stage, indicating that LODDS may be effective to predict the prognosis of colorectal SRCC in the clinic.
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16
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Liu F, Peng D, Liu XY, Liu XR, Li ZW, Wei ZQ, Wang CY. The effect of carbon nanoparticles staining on lymph node tracking in colorectal cancer: A propensity score matching analysis. Front Surg 2023; 10:1113659. [PMID: 36936663 PMCID: PMC10014567 DOI: 10.3389/fsurg.2023.1113659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose The aim of this study was to evaluate the effect of carbon nanoparticles staining (CNS) on colorectal cancer (CRC) surgery, lymph node tracing and postoperative complications using propensity score matching (PSM). Method Patients who were diagnosed with CRC and underwent surgery were retrospectively collected from a single clinical center from Jan 2011 to Dec 2021. Baseline characteristics, surgical information and postoperative information were compared between the CNS group and the non-CNS group. PSM was used to eliminate bias. Results A total of 6,886 patients were enrolled for retrospective analysis. There were 2,078 (30.2%) patients in the CNS group and 4,808 (69.8%) patients in the non-CNS group. After using 1: 1 ratio PSM to eliminate bias, there were 2,045 patients left in each group. Meanwhile, all of their baseline characteristics were well matched and there was no statistical significance between the two groups (P > 0.05). In terms of surgical information and short-term outcomes, the CNS group had less intraoperative blood loss (P < 0.01), shorter operation time (P < 0.01), shorter postoperative hospital stay (P < 0.01), less metastatic lymph nodes (P = 0.013), more total retrieved lymph nodes (P < 0.01), more lymphatic fistula (P = 0.011) and less postoperative overall complications (P < 0.01) than the non-CNS group before PSM. After PSM, the CNS group had less intraoperative blood loss (P = 0.004), shorter postoperative hospital stay (P < 0.01) and more total retrieved lymph nodes (P < 0.01) than the non-CNS group. No statistical difference was found in other outcomes (P > 0.05). Conclusion Preoperative CNS could help the surgeons detect more lymph nodes, thus better determining the patient's N stage. Furthermore, it could reduce intraoperative blood loss and reduce the hospital stay.
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17
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Asano H, Fukano H, Takagi M, Takayama T. Risk factors for the recurrence of stage II perforated colorectal cancer: A retrospective observational study. Asian J Surg 2023; 46:201-206. [PMID: 35331590 DOI: 10.1016/j.asjsur.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with perforated colorectal cancer (PCRC) experience higher recurrence rates than those with non-perforated tissue. We identified the promoting factors of stage II PCRC recurrence after R0 surgery. METHOD This retrospective observational study included patients treated for colorectal cancer at a single facility between 2007 and 2016, and compared the clinicopathological features of patients with perforating versus non-perforating stage II tumors who underwent R0 resection, while focusing on recurrences. RESULTS Thirty-two and 112 patients (predominantly men) with perforating and non-perforating tumors, respectively, were included. The perforated group had significantly higher proportions of T4 tumors than the non-perforated group (44% vs. 15%). The perforated group had significantly lower numbers of resected lymph nodes than the non-perforated group (6 vs. 17). Seven of 17 patients with follow-up data in the perforated group experienced recurrence (41%), versus 19 of 104 in the non-perforated group (18%). In the non-perforated group, male sex (89% vs. 60%, p = 0.030), T4 stage (32% vs. 9%, p = 0.029), and fewer resected lymph nodes (12.5 vs. 18.6, p = 0.003) were significantly associated with recurrence; however, no such influences on recurrence were observed in the perforated group. The recurrence sites in the perforated group were mostly local (6 patients, 86%). Conversely, recurrences in the non-perforated group were mostly distant; 8 of 19 patients (42%) had liver metastasis and 1 (5%) had lung metastasis. CONCLUSION Patients with stage II PCRC experienced higher recurrence rates regardless of clinicopathological features and had high local recurrence rates indicating possible local tumor cell dispersal owing to perforation.
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Affiliation(s)
- Hiroshi Asano
- Saitama Medical University, Department of General Surgery, Japan.
| | - Hiroyuki Fukano
- Saitama Medical University, Department of General Surgery, Japan
| | - Makoto Takagi
- Saitama Medical University, Department of General Surgery, Japan
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18
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Liu S, Yang S, Yu H, Luo H, Chen G, Gao Y, Sun R, Xiao W. A nomogram for predicting 10-year cancer specific survival in patients with pathological T3N0M0 rectal cancer. Front Med (Lausanne) 2022; 9:977652. [PMID: 36072948 PMCID: PMC9441689 DOI: 10.3389/fmed.2022.977652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background The pathological T3N0M0 (pT3N0M0) rectal cancer is the earliest stage and has the best prognosis in the locally advanced rectal cancer, but the optimal treatment remains controversial. A reliable prognostic model is needed to discriminate the high-risk patients from the low-risk patients, and optimize adjuvant chemotherapy (ACT) treatment decisions by predicting the likelihood of ACT benefit for the target population. Patients and methods We gathered and analyzed 276 patients in Sun Yat-sen University Cancer Center from March 2005 to December 2011. All patients underwent total mesorectal excision (TME), without preoperative therapy, and were pathologically proven pT3N0M0 rectal cancer with negative circumferential resection margin (CRM). LASSO regression model was used for variable selection and risk factor prediction. Multivariable cox regression was used to develop the predicting model. Optimum cut-off values were determined using X-Tile plot analysis. The 10-fold cross-validation was adopted to validate the model. The performance of the nomogram was evaluated with its calibration, discrimination and clinical usefulness. Results A total of 188 patients (68.1%) had ACT and no patients had adjuvant radiotherapy. Age, monocyte percentage, carbohydrate antigen 19–9, lymph node dissection numbers and perineural invasion (PNI) were identified as significantly associated variables that could be combined for an accurate prediction risk of Cancer Specific Survival (CSS) for pT3N0M0 patients. The model adjusted for CSS showed good discrimination with a C-index of 0.723 (95% CI: 0.652–0.794). The calibration curves showed that the nomogram adjusted for CSS was able to predict 3-, 5-, and 10-year CSS accurately. The corresponding predicted probability was used to stratify high and low-risk patients (10-year CSS: 69.1% vs. 90.8%, HR = 3.815, 95%CI: 2.102–6.924, P < 0.0001). ACT improved overall survival (OS) in the low-risk patients (10-year OS: 91.9% vs. 83.3%, HR = 0.338, 95% CI: 0.135–0.848, P < 0.0001), while it did not exhibit a significant benefit in the high-risk patients. Conclusion The present study showed that age, monocyte percentage, carbohydrate antigen 19–9, lymph node dissection numbers and PNI were independent prognostic factors for pT3N0M0 rectal cancer patients. A nomogram based on these prognostic factors effectively predicts CSS in patients, which can be conveniently used in clinical practice. ACT may improve overall survival in the low-risk patients. But the benefit of ACT was not seen in the high-risk patients.
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Affiliation(s)
- Shuang Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shanfei Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Haina Yu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huilong Luo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Gong Chen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuanhong Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Rui Sun,
| | - Weiwei Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Weiwei Xiao,
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19
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Lewis SL, Stewart KE, Garwe T, Sarwar Z, Morris KT. Retrospective Cohort Analysis of the Effect of Age on Lymph Node Harvest, Positivity, and Ratio in Colorectal Cancer. Cancers (Basel) 2022; 14:3817. [PMID: 35954480 PMCID: PMC9367268 DOI: 10.3390/cancers14153817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Colon cancer among young patients has increased in incidence and mortality over the past decade. Our objective was to determine if age-related differences exist for total positive nodes (TPN), total lymph node harvest (TLH), and lymph node ratio (LNR). Material and Methods: A retrospective review of stage III surgically resected colorectal cancer patient data in the National Cancer Database (2004−2016) was performed, reviewing TPN, TLH, and LNR (TPN/TLH). Results: Unadjusted analyses suggested significantly higher levels of TLH and TPN (p < 0.0001) in younger patients, while LNR did not differ by age group. On adjusted analysis, TLH remained higher in younger patients (<35 years 1.56 (CI 95 1.54, 1.59)). The age-related effect was less pronounced for LNR (<35 years 1.16 (CI 95 1.13, 1.2)). Conclusion: Younger patients have increased TLH, even after adjusting for known confounders, while age does not have a strong independent impact on LNR.
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Affiliation(s)
- Samara L. Lewis
- Department of Surgery, The University of Oklahoma Health Sciences Center, 800 Stanton L. Blvd, Oklahoma City, OK 73190, USA
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20
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Zou M, Xu M, Wu WQ, Gao F. Comment on "Risk factors for metachronous peritonealcarcinomatosis after radical resection for patients with nonmetastatic pT3-4 colon cancer". J Surg Oncol 2022; 126:1139-1140. [PMID: 35904134 DOI: 10.1002/jso.27001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Min Zou
- Department of Colorectal and Anal Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Ming Xu
- Department of Colorectal and Anal Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Wei-Qiang Wu
- Department of Colorectal and Anal Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Feng Gao
- Department of Colorectal and Anal Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, China
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21
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Bliggenstorfer JT, Ginesi M, Steinhagen E, Stein SL. Lymph node yield after rectal resection is a predictor of survival among patients with node-negative rectal adenocarcinoma. Surgery 2022; 172:1292-1299. [DOI: 10.1016/j.surg.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/06/2022] [Accepted: 01/28/2022] [Indexed: 10/31/2022]
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22
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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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23
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Primary tumour immune response and lymph node yields in colon cancer. Br J Cancer 2022; 126:1178-1185. [PMID: 35043009 PMCID: PMC9023574 DOI: 10.1038/s41416-022-01700-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/01/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
The mechanism underlying improved survival in non-metastatic colon cancer with higher lymph node (LN) yield is unknown. This study aimed to identify whether molecular features in the primary tumour were predictive of LN yield.
Methods
Clinical, genomic, transcriptomic, proteomic and methylation data of non-metastatic, colon cancers studied in The Cancer Genome Atlas were interrogated for associations with LN yield. Based on maximal survival effects, patients were segregated into high (>15) and low (≤15) LN yield. Gene set enrichment analysis was performed on transcriptomic changes to identify biological processes associated with LN yield. Correlations were validated in an independent set of Stage II colon cancers.
Results
High LN yield was found predictive of overall and disease-free survival. There was no association of higher LN yield and increasing nodal positivity. High LN yield was strongly linked with gene expression changes associated with the adaptive and dendritic cell immune response. This association was most prominent in node-negative cancers. Analogous findings were reproduced in the validation dataset.
Conclusion
The study shows a strong association of an activated immune response in tumours with a high LN yield. Immunogenic tumours have a better prognosis, likely explaining the survival benefit with higher LN yields.
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24
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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: 108] [Impact Index Per Article: 27.0] [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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25
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Wu Q, Zhang Z, Chen Y, Chang J, Jiang Y, Zhu D, Wei Y. Impact of Inadequate Number of Lymph Nodes Examined on Survival in Stage II Colon Cancer. Front Oncol 2021; 11:736678. [PMID: 34616683 PMCID: PMC8489731 DOI: 10.3389/fonc.2021.736678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/27/2021] [Indexed: 12/09/2022] Open
Abstract
Background Inadequate number of lymph nodes examined was not uncommon. We aimed to assess the clinical role of inadequate number of lymph nodes examined in stage II colon cancer. Methods The cancer data used in our study were obtained from the SEER (Surveillance, Epidemiology and End Results) program. Using the chi-square test, all the variables obtained in our study were compared based on whether patients had enough (≥12) lymph nodes examined. Kaplan–Meier analysis was used for overall survival (OS) analysis, and log-rank test was applied to compare different N stages with the total number of lymph nodes examined. Multivariate analysis was carried out by creating a Cox proportional hazard model to assess the prognostic roles of different variables. Results In total, 80,296 stage II/III colon cancer patients were recruited for our study. N0 stage with <8 lymph nodes examined would present with a worse prognosis compared to N1 stage (5-year OS rates, 51.6% vs. 57.1%, p < 0.001). Multivariate analyses indicated that OS of N0 stage with <8 lymph nodes examined was similar to that of N1 stage after adjusting for other recognized prognostic factors [hazard ratios (HRs) = 1.051, 95% confidence intervals (CIs) = 1.014–1.090, p = 0.018]. Conclusions N0 stage with less than eight lymph nodes examined in stage II colon cancer presented with no better OS compared to that of N1 stage. Stage II colon cancer with less than eight lymph nodes examined needed to be given greater emphasis in clinical practice.
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Affiliation(s)
- Qi Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiyuan Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yijiao Chen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiang Chang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yudong Jiang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dexiang Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Wei
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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26
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Kim D, Moon JW, Min DH, Ko ES, Ahn B, Kim ES, Lee JY. AHA1 regulates cell migration and invasion via the EMT pathway in colorectal adenocarcinomas. Sci Rep 2021; 11:19946. [PMID: 34620942 PMCID: PMC8497578 DOI: 10.1038/s41598-021-99375-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022] Open
Abstract
The progression of colorectal cancer (CRC) has been well studied and understood with the development of molecular and genetic techniques. However, specific marker(s) that could be used to predict lymph node (LN) involvement, which is the most important prognostic factor for CRC, have not been identified so far. Our previous study, in which network analysis of LN(+) and LN(-) CRC gene expression was carried out with data obtained from the Cancer Genome Atlas, led to the identification of AHA1. AHA1 is a co-chaperone activator of the Hsp90 ATPase activity. However, the role of AHA1 expression in cancer cells is still unclear. To investigate how AHA1 expression regulates the cancer cell progression and/or metastasis of human CRC, the expression levels of AHA1 and Hsp90 were examined in 105 CRC tissue samples and compared with those in paired normal tissue. The RNA expression levels of AHA1 and Hsp90aa1, but not Hsp90ab, were significantly higher in cancer tissues than in adjacent paired normal tissues (p = 0.032 and p = 0.0002, respectively). In particular, AHA1, but not Hsp90aa1 and Hsp90ab, was closely associated with the TNM stage, LN stage, and tumor metastasis (p = 0.035, p = 0.012, and p = 0.0003, respectively). Moreover, the expression of AHA1 was not only higher in the CRC cell lines than in the normal colon fibroblast cell line but was also associated with the progression of these CRC cell lines. Overexpression of AHA1 in SW480 cells increased, whereas suppression of AHA1 expression in HCT116 cells reduced cell migration and invasion through the regulation of Snail, E-cadherin, pSRC, and pAKT, which are associated with EMT signaling. Taken together, our study suggests that AHA1 contributes to the metastatic advantage of human CRC.
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Affiliation(s)
- Dasom Kim
- Department of Pathology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Department of Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Wook Moon
- BK21 FOUR Convergence & Translational Biomedicine Education Research Center, Department of Anatomy, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Hwa Min
- Department of Pathology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Department of Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Ko
- Department of Pathology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Department of Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bokyung Ahn
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yun Lee
- Department of Pathology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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27
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Ogawa S, Itabashi M, Bamba Y, Tani K, Yamaguchi S, Yamauchi S, Sugihara K. Stage II colon cancer staging using the number of retrieved lymph nodes may be superior to current TNM staging for prognosis stratification: the Japanese study group for postoperative follow-up of colorectal cancer. Int J Colorectal Dis 2021; 36:2205-2214. [PMID: 34302501 DOI: 10.1007/s00384-021-03990-y] [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: 07/08/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of the study was to compare staging of stage II colon cancer using the number of retrieved lymph nodes (RN) to current TNM staging for stratification of prognosis. METHODS The subjects were 6307 patients with stage II colon cancer who underwent curative resection at 24 Japanese institutions. The cutoff for the number of RN was established using Akaike information criterion (AIC) values for relapse-free survival (RFS) and overall survival (OS). Comparison of survival using TNM and T + RN (TRN) staging was performed using a Cox proportional hazards regression model. RESULTS AIC was lowest for 14 retrieved lymph nodes for RFS and OS. This number was used as the cutoff. In multivariate analysis, age (≥ 69), male gender, V1, CEA (> 5), pT (T4a, T4b), and RN-L were independent factors associated with RFS and OS. Six combinations of pT and RN categories were used to establish three subgroups: TRN stages IIA, IIB, and IIC. The 5-year RFS was 83.9%, 72.3%, and 71.8% in TNM stages IIA, IIB, and IIC; and 86.0%, 76.9%, and 60.3% in TRN stages IIA, IIB, and IIC. The 5-year OS was 90.0%, 81.3%, and 82.6% for the TNM stages; and 91.6%, 85.0%, and 71.9% for the TRN stages. The AIC for RFS was lower for TRN (22,318.2) than for TNM (22,390.6), and that for OS was also lower for TRN (16,285.3) than for TNM (16,355.1). CONCLUSION Stage II colon cancer staging using the number of retrieved lymph nodes may be superior to current TNM staging for prognosis stratification.
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Affiliation(s)
- Shimpei Ogawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoshiko Bamba
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kimitaka Tani
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shigeki Yamaguchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shinichi Yamauchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kenichi Sugihara
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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28
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Valadão M, Cesar D, Véo CAR, Araújo RO, do Espirito Santo GF, Oliveira de Souza R, Aguiar S, Ribeiro R, de Castro Ribeiro HS, de Souza Fernandes PH, Oliveira AF. Brazilian society of surgical oncology: Guidelines for the surgical treatment of mid-low rectal cancer. J Surg Oncol 2021; 125:194-216. [PMID: 34585390 DOI: 10.1002/jso.26676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third leading cause of cancer in North America, Western Europe, and Brazil, and represents an important public health problem. It is estimated that approximately 30% of all the CRC cases correspond to tumors located in the rectum, requiring complex multidisciplinary treatment. In an effort to provide surgeons who treat rectal cancer with the most current information based on the best evidence in the literature, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guidelines for rectal cancer treatment that is focused on the main topics related to daily clinical practice. OBJECTIVES The SBCO developed the present guidelines to provide recommendations on the main topics related to the treatment of mid-low rectal cancer based on current scientific evidence. METHODS Between May and June 2021, 11 experts in CRC surgery met to develop the guidelines for the treatment of mid-low rectal cancer. A total of 22 relevant topics were disseminated among the participants. The methodological quality of a final list with 221 sources was evaluated, all the evidence was examined and revised, and the treatment guideline was formulated by the 11-expert committee. To reach a final consensus, all the topics were reviewed via a videoconference meeting that was attended by all 11 of the experts. RESULTS The prepared guidelines contained 22 topics considered to be highly relevant in the treatment of mid-low rectal cancer, covering subjects related to the tests required for staging, surgical technique-related aspects, recommended measures to reduce surgical complications, neoadjuvant strategies, and nonoperative treatments. In addition, a checklist was proposed to summarize the important information and offer an updated tool to assist surgeons who treat rectal cancer provide the best care to their patients. CONCLUSION These guidelines summarize concisely the recommendations based on the most current scientific evidence on the most relevant aspects of the treatment of mid-low rectal cancer and are a practical guide that can help surgeons who treat rectal cancer make the best therapeutic decision.
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Affiliation(s)
- Marcus Valadão
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Daniel Cesar
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | - Rodrigo Otávio Araújo
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | | | - Samuel Aguiar
- Department of Surgical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Reitan Ribeiro
- Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
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29
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Feng H, Lyu Z, Liang W, Cai G, Deng Z, Jiang M, Wu D, Li Y. Optimal examined lymph node count in node-negative colon cancer should be determined. Future Oncol 2021; 17:3865-3872. [PMID: 34287061 DOI: 10.2217/fon-2021-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: We aimed to investigate the association between optimal examined lymph node (ELNs) and overall survival to determine the optimal cutoff point. Methods: Cox models and locally weighted scatterplot smoothing were used to fit hazard ratios and explore an optimal cutoff point based on the Chow test. Results: Overall survival increased significantly with the corresponding increase in the number of ELNs after adjusting for covariates. In Chow's test, the optimal cutoff point for node-negative colon cancer was 15, which was validated in both cohorts after controlling for confounders (Surveillance, Epidemiology, and End Results database: hazard ratio: 0.701, p < 0.001; single-center: HR: 0.563, p = 0.031). Conclusions: We conservatively suggest that the optimal number of ELNs for prognostic stratification is 15 in node-negative colon cancer.
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Affiliation(s)
- Huolun Feng
- Department of General Surgery, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, PR China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Zejian Lyu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Weijun Liang
- Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, Guangdong 529000, PR China
| | - Guanfu Cai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Zhenru Deng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Meiyu Jiang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Deqing Wu
- Department of General Surgery, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, PR China
| | - Yong Li
- Department of General Surgery, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, PR China
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30
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Wang G, Li Q, Chen W. Chemotherapy in the treatment of different histological types of appendiceal cancers: a SEER based study. BMC Cancer 2021; 21:778. [PMID: 34225672 PMCID: PMC8259079 DOI: 10.1186/s12885-021-08502-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/09/2021] [Indexed: 01/12/2023] Open
Abstract
Background Due to its rarity and high heterogeneity, neither established guidelines nor prospective data are currently available for using chemotherapy in the treatment of appendiceal cancer. This study was to determine the use of chemotherapy and its potential associations with survival in patients with different histological types of the cancer. Methods Patients with histologically different appendiceal cancers diagnosed during 1998–2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The role and effect of chemotherapy were examined in the treatment of the disease. The Kaplan-Meier method was applied to construct survival curves and significance was examined by Log-rank test. Cox proportional hazard models were used to analyze the impact of chemotherapy and other variables on survival in these patients. Results A total of 8733 appendiceal cancer patients were identified from the database. Chemotherapy was administrated at highly variable rates in different histological types of appendiceal cancer. As high as 64.0% signet ring cell carcinoma (SRCC), 46.4% of mucinous adenocarcinomas (MAC), 40.6% of non-mucinous adenocarcinoma (NMAC) and 43.9% of mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) were treated with chemotherapy, whereas only 14.7% of goblet cell carcinoma (GCC), 5% neuroendocrine tumors (NETs) and 1.6% carcinomas (NEC) received chemotherapy. In all patients combined, chemotherapy significantly improved overall survival during the entire study period and cancer-specific survival was improved during in cases from 2012–2016. Further multivariate analysis showed that both cancer-specific and overall survival was significantly improved with chemotherapy in patients with MAC, NMAC and SRCC, but not for patients with GCC, MiNENs, NETs and NECs. Number (> 12) of lymph node sampled was associated with survival of patients with most histological types of cancer under study. Other prognostic factors related to individual histological types were identified. Conclusions Chemotherapy is administrated at highly variable rates in different histological types of appendiceal cancer. Efficacy of chemotherapy in the treatment of these cancers has been improved in recent years and is significantly associated with better survival for patients with NMAC, MAC, and SRCC. Adequate lymph node sampling may result in a survival benefit for most of these patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08502-3.
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Affiliation(s)
- Gang Wang
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Qiken Li
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Weiping Chen
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
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Lee SY, Lee J, Park HM, Kim CH, Kim HR. Perineural invasion and number of retrieved lymph nodes are prognostic factors for T2N0 colon cancer. Langenbecks Arch Surg 2021; 406:1979-1985. [PMID: 34129107 DOI: 10.1007/s00423-021-02172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The prognosis of pathological T2N0 colon cancer has not been adequately investigated. This study aimed to determine the prognostic factors for pathological T2N0 colon cancer by comparing it with those for pathological T3N0 colon cancer. METHODS We retrospectively reviewed patients with primary colon cancer who underwent curative resection between January 2007 and December 2015 and included 889 patients with postoperative pathological T2-3N0M0 disease. The clinicopathological characteristics were analyzed to identify the independent prognostic factors. RESULTS Pathological T2 (n = 185, 20.8%) and T3 (n = 704, 79.2%) tumors showed no difference in the 5-year disease-free survival (5Y DFS) rate (95.8% vs. 93.2%, p = 0.257) after a median follow-up of 55 months (range, 1-106 months). Multivariate Cox regression analysis showed that perineural invasion (hazard ratio [HR] = 2.041, 95% confidence interval [CI] 1.122-3.712, p = 0.019) and number of retrieved lymph nodes < 12 (HR = 2.994, 95% CI 1.327-6.753, p = 0.008) were independent prognostic factors for DFS. Pathological T2 tumors with poor prognostic factors showed similar 5Y DFS as that of T3 tumors with poor prognostic factors (88.9% vs. 88.6%, p = 0.916), but not with T3 tumors without poor prognostic factors (88.9% vs. 95.0%, p = 0.089). CONCLUSION Pathological T2N0 colon cancer showed oncologic outcomes similar to that of T3N0 colon cancer. Therefore, more intensive surveillance is necessary for patients with high-risk T2N0 colon cancer.
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Affiliation(s)
- Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Korea
| | - Jaram Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Korea
| | - Hyeong-Min Park
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Korea.
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Fang C, Nie P, Jing P, Zhang Y, Yang L, Yu Y, Wang C, Zhou Z. Effects of Adjuvant Therapy Compliance and Anastomotic Leakage on the Oncologic Outcomes of Patients With Rectal Cancer After Curative Resection. Dis Colon Rectum 2021; 64:689-696. [PMID: 33394777 PMCID: PMC8096314 DOI: 10.1097/dcr.0000000000001824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anastomotic leakage might be directly or indirectly related to the prognosis of patients with rectal cancer. OBJECTIVE This study aimed to investigate whether anastomotic leakage affects the oncologic outcomes in patients with rectal cancer. DESIGN This was a retrospective analysis of prospectively collected data. SETTINGS This study was conducted at a teaching hospital between January 2009 and December 2013. PATIENTS Patients who underwent curative resection for primary rectal cancer were included. MAIN OUTCOME AND MEASURE Kaplan-Meier analyses were used to evaluate disease-free survival and overall survival. RESULTS The overall incidence of anastomotic leakage was 2.7% (107/3865). Local recurrence was more frequent in patients with anastomotic leakage than in those without (14.0% vs 6.7%; p = 0.007). By multivariate analysis, anastomotic leakage was associated with increased local recurrence rate (p = 0.014) and poorer overall survival (p = 0.011). In subgroup analysis, compared with other pathologic risk factors, anastomotic leakage was associated with higher occurrence of local and distant recurrence in patients with stage II rectal cancer (p = 0.031 and <0.001). In patients with stage III rectal cancers, adjuvant therapy was more likely to be delayed or canceled in those experiencing anastomotic leakage (63 vs 39 d, p < 0.001; 37.3% vs 66.7%, p < 0.001). In addition, this patient group had the worst survival outcome when compared with those without anastomotic leakage and those with timely adjuvant therapy (5-year disease-free survival rate, p = 0.013; 5-year overall survival rate, p = 0.001). LIMITATIONS This study is limited by its retrospective nature. CONCLUSIONS There was a robust association between anastomotic leakage and local recurrence, while also potentially affect long-term survival of the patient group. Delayed or cancelled adjuvant therapy administration because of anastomotic leakage may partly account for the poorer survival in those patients with advanced rectal cancer. See Video Abstract at http://links.lww.com/DCR/B459. EFECTOS DE OBSERVANCIA DE TERAPIA ADYUVANTE Y FUGA ANASTOMTICA, EN RESULTADOS ONCOLGICOS DE PACIENTES CON CNCER RECTAL, DESPUS DE UNA RESECCIN CURATIVA ANTECEDENTES:La fuga anastomótica podría estar relacionada directa o indirectamente, con el pronóstico de los pacientes con cáncer de recto.OBJETIVO:El estudio tuvo como objetivo investigar si la fuga anastomótica afecta los resultados oncológicos, en pacientes con cáncer de recto.DISEÑO:Fue un análisis retrospectivo de datos recolectados prospectivamente.AJUSTE:El estudio se realizó en un hospital universitario entre enero de 2009 y diciembre de 2013.PACIENTES:Pacientes sometidos a resección curativa por cáncer rectal primario.PRINCIPALES MEDIDAS DE RESULTADO:Se utilizaron análisis de Kaplan-Meier para evaluar la supervivencia libre de enfermedad y supervivencia general.RESULTADOS:La incidencia global de fuga anastomótica fue del 2,7% (107/3865). La recurrencia local fue más frecuente en pacientes con fuga anastomótica, que en aquellos sin ella (14,0% frente a 6,7%, p = 0,007). Por análisis multivariado, la fuga anastomótica se asoció con una mayor tasa de recurrencia local (p = 0,014) y una peor supervivencia general (p = 0,011). En el análisis de subgrupos, en comparación con otros factores de riesgo patológicos, la fuga anastomótica se asoció con una mayor incidencia de recidiva local y a distancia en pacientes con cáncer rectal en estadio II (p = 0,031 y <0,001, respectivamente). En pacientes con cáncer rectal estadio III, la terapia adyuvante tuvo más probabilidades de retrasarse o cancelarse en aquellos que sufrían fuga anastomótica (63 vs 39 días, p <0,001; 37,3% vs 66,7%, p <0,001). Y este grupo de pacientes tuvo el peor resultado de supervivencia en comparación con aquellos sin fuga anastomótica y aquellos con terapia adyuvante oportuna (tasa de supervivencia libre de enfermedad a 5 años, p = 0,013; tasa de supervivencia global a 5 años, p = 0,001).LIMITACIONES:El estudio está limitado por su naturaleza retrospectiva.CONCLUSIONES:Hubo una sólida asociación entre la fuga anastomótica y la recurrencia local, mientras que también afecta potencialmente la supervivencia a largo plazo, del grupo de pacientes. La administración de terapia adyuvante retrasada o cancelada debido a una fuga anastomótica, puede explicar en parte, la menor supervivencia en aquellos pacientes con cáncer rectal avanzado. Consulte Video Resumen en http://links.lww.com/DCR/B459.
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Affiliation(s)
- Chao Fang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Nie
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Pengfei Jing
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yunlu Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yongyang Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Xie JB, Pang YS, Li X, Wu XT. Critical prognostic value of the log odds of negative lymph nodes/tumor size in rectal cancer patients. World J Clin Cases 2021; 9:3531-3545. [PMID: 34046453 PMCID: PMC8130081 DOI: 10.12998/wjcc.v9.i15.3531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/02/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The number of negative lymph nodes (NLNs) and tumor size are associated with prognosis in rectal cancer patients undergoing surgical resection. However, little is known about the prognostic significance of the NLN count after adjusting for tumor size.
AIM To assess the prognostic impact of the log odds of NLN/tumor size (LONS) in rectal cancer patients.
METHODS Data of patients with stage I–III rectal cancer were extracted from the Surveillance, Epidemiology, and End Results Program database. These patients were randomly divided into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were used to determine the prognostic value of the LONS. The optimal cutoff values of LONS were calculated using the "X-tile" program. Stratified analysis of the effect of LONS on cancer-specific survival (CSS) and overall survival (OS) were performed. The Kaplan-Meier method with the log-rank test was used to plot the survival curve and compare the survival data among the different groups.
RESULTS In all, 41080 patients who met the inclusion criteria were randomly divided into a training cohort (n = 28775, 70%) and a validation cohort (n = 12325, 30%). Univariate and multivariate analyses identified the continuous variable LONS as an independent prognostic factor for CSS [training cohort: Hazard ratio (HR) = 0.47, 95% confidence interval (CI): 0.44–0.51, P < 0.001; validation cohort: HR = 0.46, 95%CI: 0.41-0.52, P < 0.001] and OS (training cohort: HR = 0.53, 95%CI: 0.49-0.56, P < 0.001; validation cohort: HR = 0.52, 95%CI: 0.42-0.52, P < 0.001). The X-tile program indicated that the difference in CSS was the most significant for LONS of -0.8, and the cutoff value of -0.4 can further distinguish patients with a better prognosis in the high LONS group. Stratified analysis of the effect of the categorical variable LONS on CSS and OS revealed that LONS was also an independent predictor, independent of pN stage, pT stage, tumor-node-metastasis stage, site, age, sex, the number of examined lymph nodes, race, preoperative radiotherapy and carcinoembryonic antigen level.
CONCLUSION LONS is associated with improved survival of rectal cancer patients independent of other clinicopathological factors.
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Affiliation(s)
- Jie-Bin Xie
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College China, Nanchong 637200, Sichuan Province, China
| | - Yue-Shan Pang
- Department of Geriatrics, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong 637200, Sichuan Province, China
| | - Xun Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College China, Nanchong 637200, Sichuan Province, China
| | - Xiao-Ting Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer. Eur Surg 2021. [DOI: 10.1007/s10353-021-00714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Summary
Objective
To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages.
Methods
In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time.
Results
From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes.
Conclusion
In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.
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Li Q, Wang G, Luo J, Li B, Chen W. Clinicopathological factors associated with synchronous distant metastasis and prognosis of stage T1 colorectal cancer patients. Sci Rep 2021; 11:8722. [PMID: 33888776 PMCID: PMC8062534 DOI: 10.1038/s41598-021-87929-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/06/2021] [Indexed: 01/21/2023] Open
Abstract
It is rare and understudied for patients with stage T1 colorectal cancer to have synchronous distant metastasis. This study was to determine the clinicopathological factors associated with distant metastasis and prognosis. T1 colorectal cancer patients diagnosed between 2010 and 2015 were obtained from the SEER database. Logistic regression was applied to determine risk factors related to distant metastasis. Cox-proportional hazard models were used to identify the prognostic factors for patients with distant metastasis. Among 21,321 patients identified, 359 (1.8%) had synchronous distant metastasis and 1807 (8.5%) had lymph node metastasis. Multivariate analysis revealed that younger age, positive serum CEA, larger tumor size, positive tumor deposit, perineural invasion, lymph node metastasis, histology of non-adenocarcinoma and poorer differentiation were significantly associated with the increased risk of synchronous distant metastasis. Older age, female, Black, positive CEA, positive lymph node metastasis, positive tumor deposit, larger tumor size, no chemotherapy, inadequate lymph node harvesting and no metastasectomy were correlated with worse survival in these patients with synchronous distant metastasis. Patients with metastasis to the liver displayed the highest rate of positive CEA. We conclude that T1 colorectal cancer patients with multiple risk factors need thorough examinations to exclude synchronous distant metastasis. Chemotherapy, adequate lymph node cleaning and metastasectomy are associated with improved survival for those patients with distant metastases. Positive serum CEA may be useful in predicting distant metastases in patients at stage T1.
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Affiliation(s)
- Qiken Li
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
| | - Gang Wang
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
| | - Jun Luo
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
| | - Bo Li
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
| | - Weiping Chen
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China.
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Zhu J, Hao J, Ma Q, Shi T, Wang S, Yan J, Chen R, Xu D, Jiang Y, Zhang J, Li J. A Novel Prognostic Model and Practical Nomogram for Predicting the Outcomes of Colorectal Cancer: Based on Tumor Biomarkers and Log Odds of Positive Lymph Node Scheme. Front Oncol 2021; 11:661040. [PMID: 33937076 PMCID: PMC8085421 DOI: 10.3389/fonc.2021.661040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background Emerging evidence shows that serum tumor biomarkers (TBs) and log odds of positive lymph node scheme (LODDS) are closely associated with the prognosis of colorectal cancer (CRC) patients. The aim of our study is to validate the predictive value of TBs and LODDS clinically and to develop a robust prognostic model to predict the overall survival (OS) of patients with CRC. Methods CRC patients who underwent radical resection and with no preoperative chemotherapy were enrolled in the study. The eligible population were randomized into training (70%) and test (30%) cohorts for the comprehensive evaluation of the prognostic model. Clinical implications of serum biomarkers and LODDS were identified by univariate and multivariate Cox proportion regression analysis. The predictive ability and discriminative performance were evaluated by Kaplan–Meier (K–M) curves and receiver operating characteristic (ROC) curves. Clinical applicability of the prognostic model was assessed by decision curve analysis (DCA), and the corresponding nomogram was constructed based on the above factors. Results A total of 1,202 eligible CRC patients were incorporated into our study. Multivariable COX analysis demonstrated that CA199 (HR = 1.304), CA125 (HR = 1.429), CEA (HR = 1.307), and LODDS (HR = 1.488) were independent risk factors for OS (all P < 0.0001). K–M curves showed that the high-risk group possessed a shorter OS than the low-risk counterparts. The area under curves (AUCs) of the model for 1-, 3- and 5-year OS were 86.04, 78.70, and 76.66% respectively for the train cohort (80.35, 77.59, and 74.26% for test cohort). Logistic DCA and survival DCA confirmed that the prognostic model displayed more clinical benefits than the conventional AJCC 8th TNM stage and CEA model. The nomograms were built accordingly, and the calibration plot for the probability of survival at 3- or 5-years after surgery showed an optimal agreement between prediction and actual observation. Conclusions Preoperative serum TBs and LODDS have significant clinical implications for CRC patients. A novel prognostic model incorporating common TBs (CA199, CA125, and CEA) and LODDS displayed better predictive performance than both single factor and the TNM classification. A novel nomogram incorporating TBs and LODDS could individually predict OS in patients with CRC.
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Affiliation(s)
- Jun Zhu
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jun Hao
- Department of Experiment Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qian Ma
- School of Clinical Medicine, Xi'an Medical University, Xi'an, China
| | - Tingyu Shi
- Health Company, Airborne Special Operations Brigade Support Battalion, Xiaogan, China
| | - Shuai Wang
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jingchuan Yan
- Department of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Rujie Chen
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Dong Xu
- Department of Experiment Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yu Jiang
- Department of Experiment Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jian Zhang
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, The Fourth Military Medical University, Xi'an, China
| | - Jipeng Li
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Zhang H, Sun G, Zheng K, Lou Z, Gao XH, Meng RG, Furnée EJB, Zhang W. Prognostic factors in patients with complete response of the tumour (ypT0) after neoadjuvant chemoradiotherapy and radical resection of rectal cancer. ANZ J Surg 2021; 91:E190-E195. [PMID: 33559307 DOI: 10.1111/ans.16544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/13/2020] [Accepted: 12/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are only a few studies on the prognosis of patients with complete response of the tumour (ypT0) after neoadjuvant chemoradiotherapy (NCRT) and radical resection of rectal cancer. The aim of the study was to identify prognostic factors with regard to oncological outcome in ypT0 patients after NCRT and radical resection. METHODS All ypT0 patients with rectal cancer after NCRT and radical resection between January 2010 and June 2019 were included. Cox univariate and multivariate regression analyses were used to determine the prognostic factors of these patients. RESULTS Seventy-six patients with ypT0 rectal cancer were included. In nine patients (11.8%), lymph node metastasis was identified. Age, gender, elevated carcinoembryonic antigen (CEA) and ypN+ were risk factors associated with a worse 5-year disease-free survival (DFS) rate in univariate analysis (P = 0.08, 0.14, 0.007 and 0.003, respectively). In multivariate analysis, ypN+ and elevated CEA before NCRT were independent risk factors for worse 5-year DFS (P = 0.005 and 0.021, respectively). Elevated CEA before NCRT, post-operative chemotherapy and ypN+ were risk factors associated with worse overall survival in univariate analysis (P = 0.14, 0.002 and 0.17, respectively). However, in multivariate analysis, none of these three factors were independent risk factors for worse overall survival (P = 0.20, 0.34 and 0.06, respectively). CONCLUSION ypN+ and elevated CEA before NCRT were found to be independent risk factors for an unfavourable DFS in ypT0 patients with complete response of the tumour after neoadjuvant chemoradiotherapy for rectal cancer.
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Affiliation(s)
- Hang Zhang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China.,Department of Hepatobiliary Surgery, Hospital of the PLA Navy, Qingdao, China
| | - Ge Sun
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China.,Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Kuo Zheng
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Zheng Lou
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Xian H Gao
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Rong G Meng
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Edgar J B Furnée
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
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Evaluation of the prognostic relevance of the recommended minimum number of lymph nodes in colorectal cancer-a propensity score analysis. Int J Colorectal Dis 2021; 36:779-789. [PMID: 33454816 PMCID: PMC7952332 DOI: 10.1007/s00384-021-03835-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Nodal status in colorectal cancer (CRC) is an important prognostic factor, and adequate lymph node (LN) staging is crucial. Whether the number of resected and analysed LN has a direct impact on overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) is much discussed. Guidelines request a minimum number of 12 LN to be analysed. Whether that threshold marks a prognostic relevant cut-off remains unknown. METHODS Patients operated for stage I-III CRC were identified from a prospectively maintained database. The impact of the number of analysed LN on OS, CSS and DFS was assessed using Cox regression and propensity score analysis. RESULTS Of the 687 patients, 81.8% had ≥ 12 LN resected and analysed. Median LN yield was 17.0 (IQR 13.0-23.0). Resection and analysis of ≥ 12 LN was associated with improved OS (HR = 0.73, 95% CI: 0.56-0.95, p = 0.033), CSS (HR 0.52, 95% CI: 0.31-0.85, p = 0.030) and DFS (HR = 0.73, 95% CI: 0.57-0.95, p = 0.030) in multivariate Cox analysis. After adjusting for biasing factors with propensity score matching, resection of ≥ 12 LN was significantly associated with improved OS (HR = 0.59; 95% CI: 0.43-0.81; p = 0.002), CSS (HR = 0.34; 95% CI: 0.20-0.60; p < 0.001) and DFS (HR = 0.55; 95% CI: 0.41-0.74; p < 0.001) compared to patients with < 12 LN. CONCLUSION Eliminating biasing factors by a propensity score matching analysis underlines the prognostic importance of the number of analysed LN. The set threshold marks the minimum number of required LN but nevertheless represents a cut-off regarding outcome in stage I-III CRC. This analysis therefore highlights the significance and importance of adherence to surgical oncological standards.
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Liu P, Tan J, Tan Q, Xu L, He T, Lv Q. Application of Carbon Nanoparticles in Tracing Lymph Nodes and Locating Tumors in Colorectal Cancer: A Concise Review. Int J Nanomedicine 2020; 15:9671-9681. [PMID: 33293812 PMCID: PMC7719328 DOI: 10.2147/ijn.s281914] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
Background Accurate lymph node (LN) staging has considerably prognostic and therapeutic value in patients with colorectal cancer (CRC). The purpose of this study is to evaluate the feasibility of applying carbon nanoparticles (CNPs) to track LN metastases in CRC. Methods Two researchers independently screened publications in PubMed, EMBASE, Cochrane and Ovid MEDLINE databases. The keywords were (carbon nanoparticles OR activated carbon nanoparticles) AND (colon cancer OR rectal cancer OR colorectal cancer). Titles and abstracts of the articles were meticulously read to rule out potential publications. Next, full texts of the ultimately obtained eligible publications were retrieved and analyzed in detail. Results The search produced 268 publications, and 140 abstracts were identified after a bibliographic review. Finally, 20 studies relevant to our subject were obtained; however, only 14 papers met our inclusion criteria and were included for final review. All studies included have compared the control group with carbon nanoparticles group (control group, defined as nontattooed group; and carbon nanoparticles group, defined as administering carbon nanoparticles during surgery) for their efficacy in intraoperative detecting and positioning. After analysis, appreciably less amount of bleeding (3/5 trials), shorter operation time (2/4 trials), and shorter time to detect lesions and dissect LNs (2/2 trials) were revealed in CNPs group compared to control group. Thirteen studies have recorded the numbers of the harvested LNs in both groups; meanwhile, CNPs group shows superiority to control group in LN retrieval as well (11/13 trials), which also could effectively aid in locating and harvesting more LNs with diameter below 5 mm. Conclusion The tracing technique for CNPs is a safe and useful strategy both in localizing tumor and tracing LNs in CRC surgery. But there is still a need for more randomized controlled trials to further establish its contribution to patient survival.
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Affiliation(s)
- Pengcheng Liu
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Jie Tan
- Department of Orthopaedic Surgery & Orthopaedic Institute, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Qiuwen Tan
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Li Xu
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Tao He
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Qing Lv
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
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Prognostic significance of lymph node yield in patients with synchronous colorectal carcinomas. Int J Colorectal Dis 2020; 35:2273-2282. [PMID: 32789742 DOI: 10.1007/s00384-020-03700-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The National Comprehensive Cancer Network (NCCN) guidelines recommend examination of a minimum of 12 lymph nodes (LNs) for accurate staging of a single case of colorectal cancer. However, the guidelines do not support the examination of LNs in synchronous colorectal carcinoma (SCC). This study aimed to investigate the association between lymph node yield and the prognosis of SCC patients. METHODS Synchronous colorectal carcinoma patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database over a 10-year interval (2004 to 2013). Systematic dichotomization for optimal cut-off point identification was performed using X-tile. The baseline for the two LNs groups generated was balanced using the propensity score matching (PSM) method. RESULTS A total of 4616 patients met the inclusion criteria. The cut-off number for lymph node retrieved from a single patient was 15 and 12 for the first- and second-time diagnosis of SCC, respectively. Age, T category, N category, tumor grade, tumor site, tumor size, and radiation sequence were not balanced in the two groups. After adjusting the baseline in the two groups, the same results were observed. Age, T category, N category, tumor site had a partial effect on lymph node yield. There might be some biological characteristics of the tumor that influence lymph node yield. CONCLUSIONS Retrieval of fewer than 15 LNs at the first time of SCC diagnosis indicates worse SCC prognosis. Because factors such as manner of surgical examination influence SCC prognosis, specimens should be preserved for at least 6 months to enable reevaluation should there be a need. Irb: IRB approval is not required because the SEER data are freely accessible.
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Carrasco-Peña F, Bayo-Lozano E, Rodríguez-Barranco M, Petrova D, Marcos-Gragera R, Carmona-Garcia MC, Borras JM, Sánchez MJ. Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6697. [PMID: 32938004 PMCID: PMC7558406 DOI: 10.3390/ijerph17186697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 01/19/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We conducted a retrospective high-resolution population-based study of 1050 incident CRC cases from the cancer registries of Granada and Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence (on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95% confidence interval (CI) 0.28-0.45]. Analysis of the separate indicators showed that patients for whom complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46-0.73], as did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95% CI 0.16-0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from CRC by 65% [95% CI 55-72%]. Ordering complementary imagining tests that improve staging and treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients could be especially important. In contrast, controlled delays in starting some treatments appear not to decrease survival.
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Affiliation(s)
- Francisco Carrasco-Peña
- Radiation Oncology Department, University Hospital Virgen Macarena, 41009 Sevilla, Spain; (F.C.-P.); (E.B.-L.)
| | - Eloisa Bayo-Lozano
- Radiation Oncology Department, University Hospital Virgen Macarena, 41009 Sevilla, Spain; (F.C.-P.); (E.B.-L.)
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain; (M.R.-B.); (M.-J.S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Dafina Petrova
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain; (M.R.-B.); (M.-J.S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Rafael Marcos-Gragera
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Medical Sciences Department, Faculty of Medicine, University of Girona (UdG), 17071 Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Department of Health, Government of Catalonia, 17007 Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Girona Biomedical Research Institute—IDIBGI, Salt, 17190 Girona, Spain;
| | - Maria Carmen Carmona-Garcia
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Girona Biomedical Research Institute—IDIBGI, Salt, 17190 Girona, Spain;
- Medical Oncology Department, Catalan Institute of Oncology, University Hospital Dr Josep Trueta, 17007 Girona, Spain
| | - Josep Maria Borras
- Department of Clinical Sciences, IDIBELL, University of Barcelona, Hospitalet, 08908 Barcelona, Spain;
- Department of Health, Catalonian Cancer Strategy, Hospitalet, 08908 Barcelona, Spain
| | - Maria-José Sánchez
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain; (M.R.-B.); (M.-J.S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Department of Preventive Medicine and Public Health, University of Granada, 18010 Granada, Spain
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Ning FL, Pei JP, Zhang NN, Wang J, Quan HG, Mei ZB, Zeng XT, Abe M, Zhang CD. Harvest of at least 18 lymph nodes is associated with improved survival in patients with pN0 colon cancer: a retrospective cohort study. J Cancer Res Clin Oncol 2020; 146:2117-2133. [PMID: 32285257 DOI: 10.1007/s00432-020-03212-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/04/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the correlation between number of retrieved lymph nodes (rLNs) and prognosis and further ascertain the optimal number of rLNs with a beneficial survival impact in patients with pN0 colon cancer. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was searched for pN0 colon cancer cases. X-Tile software and Kaplan-Meier survival analysis were applied to determine the optimal number of rLNs based on the minimal probability (P) value and the largest χ2 value. Univariate analyses and Cox proportional hazard regression model were used to investigate the relationship between rLN number and overall survival. Multiple analyses were conducted to assess the prognostic predictive ability of the identified optimal rLN cut-off value under different stratifications. Nomograms were established based on the independent prognostic factors selected by the multivariate analysis to predict 3- and 5-year overall survival rates of pN0 patients. RESULTS A total of 6269 pN0 colon cancer patients who underwent surgical therapy were finally included for analysis. Harvest of at least 18 lymph nodes was determined as the optimal rLN number. This cut-off rLN value (< 18 versus ≥ 18) was identified as an independent prognostic factor (P < 0.001) of overall survival via multivariate analysis. Similar findings were obtained in patients with retrieval of at least 12 lymph nodes (18 > rLNs ≥ 12 versus rLNs ≥ 18) stratified into several groups. CONCLUSIONS The number of rLNs was identified as an independent prognostic factor for pN0 colon cancer. Retrieval of at least 18 lymph nodes was associated with favorable prognosis in patients with pN0 colon cancer, and should, therefore, be regarded as an alternative cut-off value for survival analysis.
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Affiliation(s)
- Fei-Long Ning
- Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, People's Republic of China
| | - Jun-Peng Pei
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Nan-Nan Zhang
- State Key Laboratory of Cancer Biology, Institute of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jun Wang
- Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, People's Republic of China
| | - Hong-Guang Quan
- Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, People's Republic of China
| | - Zu-Bing Mei
- Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
- Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College of Wuhan University, Wuhan, People's Republic of China
| | - Masanobu Abe
- Division for Health Service Promotion, University of Tokyo, Tokyo, Japan
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Lewis A, Akopian G, Carillo S, Kaufman HS. Lymph Node Harvest in Emergent versus Elective Colon Resections. Am Surg 2020. [DOI: 10.1177/000313481207801008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality measures for prognostication of colon cancer include the removal of 12 or more lymph nodes during colon resection. The purpose of this study was to determine whether emergent surgery is associated with inadequate lymph node harvest. The National Cancer Database (NCDB) was queried for colon cancer patients operated on at Huntington Memorial Hospital, Pasadena, California, from 2005 to 2010. Demographic data, indication for surgery, surgeon, stage, lymph node harvest, tumor location, method of surgery, chemotherapy use, and survival were recorded. Univariate analyses were performed to compare lymph node harvest with the variables listed. Three hundred fifty-three patients underwent colon resection between 2005 and 2010. Two hundred ninety-six patients with Stage I to III disease underwent 253 elective (85%) and 43 emergent (15%) colectomies. There was no statistical difference between rates of adequate lymph node harvest in emergent and elective patient groups (86.0 vs 88.1%, P = 0.7). Inferior long-term survival was associated with emergent indication and inferior lymph node harvest. Lymph node harvest adequacy showed a gradual increase over time from 79.5 per cent in 2005 to 95.5 per cent in 2010. Despite a perception that emergent surgery is associated with inadequate lymphadenectomy, 5-year data from Huntington Memorial Hospital participation in NCDB does not suggest inferior lymph node harvests in patients operated on for obstruction or perforation.
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Affiliation(s)
| | | | | | - Howard S. Kaufman
- Huntington Hospital, Pasadena, California
- Huntington Medical Research Institutes, Pasadena, California
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The re-evaluation of optimal lymph node yield in stage II right-sided colon cancer: is a minimum of 12 lymph nodes adequate? Int J Colorectal Dis 2020; 35:623-631. [PMID: 31996986 DOI: 10.1007/s00384-019-03483-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Adequate lymphadenectomy is critical for accurate nodal staging and planning adjuvant therapy in colon cancer. However, the optimal lymph node (LN) yield for stage II right-sided colon cancer (RSCC) is still unclear. This population-based study aimed to determine the optimal LN yield associated with survival and LN positivity in patients with stage II RSCC. METHODS All patients with stage II-III RSCC were identified from the Surveillance, Epidemiology, and End Results database over a 10-year interval (2006-2015). The optimal threshold for LN yield was explored using an outcome-oriented approach based on survival and LN positivity. RESULTS The median number of LNs examined for all 17,385 patients with stage II RSCC was 17 (IQR 12-23). Nineteen LNs were determined as the optimal cut-off point to maximize survival benefit from lymphadenectomy. Increased LN yield was associated with a gradual increase in the risk of node positivity, with no change after 19 nodes. Compared with patients with 19 or more LNs examined, the group with fewer LNs had a significantly poor cancer-specific survival (< 12 nodes: hazard ratio (HR) 2.26, P < 0.001; 12-18 nodes: HR 1.58, P < 0.001) and overall survival (< 12 nodes: HR 1.80, P < 0.001; 12-18 nodes: HR 1.31, P < 0.001). Similar survival results were found in the validation cohort. Patients with older age, small tumor size, and appendix and transverse colon cancer were more likely to receive inadequate LN harvest. CONCLUSION A minimum of 19 LNs is needed to be examined for optimal survival and adequate node staging in lymph node-negative RSCC.
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Yu N, Liu H, Li J, Chen S. Using low concentration sodium hypochlorite to improve colorectal surgical specimen lymph node harvest. Mol Clin Oncol 2020; 12:519-524. [PMID: 32337032 DOI: 10.3892/mco.2020.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 01/01/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nanrong Yu
- Department of Gastrointestinal Tumor Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Haiying Liu
- Department of Gastrointestinal Tumor Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Jianchang Li
- Department of Gastrointestinal Tumor Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Shicai Chen
- Department of Gastrointestinal Tumor Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
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Janež J, Škapin AD. Comparison of a Five-Year Survival and Cancer Recurrence between Laparoscopically Assisted and Open Colonic Resections due to Adenocarcinoma-a Single Centre Experience. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:93. [PMID: 32102382 PMCID: PMC7073668 DOI: 10.3390/medicina56020093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: When resecting colon adenocarcinoma, surgeons decide between the use of laparoscopically assisted and open surgery. Laparoscopic resection is known to have short-term benefits over an open operation. However, researchers are not as unified about the long-term findings. The aim of this research is to elaborate on five-year post-operative differences in survival and cancer recurrence between these two different approaches. Materials and methods: 74 enrolled patients were evaluated five years after a primary operation. We collected dates of deaths of deceased patients and time after operation of possible recurrences. Carcinoma staging was done by a pathologist after operation. Blood samples were taken before surgery in order to measure tumor markers (CA19-9 and CEA). Results: Survival after colonic adenocarcinoma surgery did not differ between the two different surgical approaches (p = 0.151). Recurrence of cancer was not associated with the type of operation (p = 0.532). Patients with recurrence had a 37.6 times greater hazard ratio of dying (95% CI: [12.0, 118]; p < 0.001). Advanced age adversely affected survival: patients aged <65 and 65 years had a 97%, and 57% survival rate, respectively. Patients with elevated tumor markers at operation had a 19.1 greater hazard ratio of dying (95% CI: [5.16, 70.4]; p<0.001). Patients with different TNM stages did not have any statistically significant differences in survival (HRII = 2.49; 95% CI: [0.67, 9.30]; pII = 0.173) (HRIII = 2.18; 95% CI: [0.58, 8.12]; pIII = 0.246) or recurrence (p = 0.097). Conclusion: The obtained results suggest that laparoscopic resection of colon cancer is not inferior from an oncologic point of view and results in a similar long-term survival and disease-free interval. Recurrence of carcinoma, older age at initial operation and elevated tumor markers, above a pre-set threshold at operation, were found to be independent factors of lower survival. We believe that the obtained results will be of benefit when choosing treatment for colon adenocarcinoma.
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Affiliation(s)
- Jurij Janež
- Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1104 Ljubljana, Slovenia;
| | - Armand D Škapin
- Faculty of Medicine, University of Ljubljana, 1104 Ljubljana, Slovenia;
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Oncologic Outcome and Morbidity in the Elderly Rectal Cancer Patients After Preoperative Chemoradiotherapy and Total Mesorectal Excision: A Multi-institutional and Case-matched Control Study. Ann Surg 2019; 269:108-113. [PMID: 28742692 DOI: 10.1097/sla.0000000000002443] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the toxicity and oncologic outcome of neoadjuvant chemoradiotherapy (CRT) followed by curative total mesorectal excision (TME) in the elderly (≥70 yrs) and younger (<70 yrs) rectal cancer patients. BACKGROUND Sufficient data for elderly rectal cancer patients who received definitive trimodality have not been accumulated yet. PATIENTS AND METHODS A total of 1232 rectal cancer patients who received neoadjuvant CRT and TME were enrolled in this study. After propensity-score matching, 310 younger patients and 310 elderly patients were matched with 1:1 manner. Treatment response, toxicity, surgical outcome, recurrence, and survival were assessed and compared between the 2 groups of patients. RESULTS The median age was 58 years for the younger patient group and 74 years for the elderly group. Pathologic complete response rates were not significantly different between the 2 groups (younger and elderly: 17.1% vs 14.8%, P = 0.443). The 5-year recurrence-free survival (younger and elderly: 67.7% vs 65.5%, P = 0.483) and overall survival (younger and elderly: 82.9% vs. 79.5%, P = 0.271) rates were not significantly different between the 2 groups either. Adjuvant chemotherapy after surgery was less frequently delivered to the elderly than that to younger patients (83.9% vs 69.0%). Grade 3 or higher acute hematologic toxicity was observed more frequently in the elderly than that in the younger group (9.0% vs 16.1%, P = 0.008). Late complication rate was higher in the elderly group compared with that in the younger group without statistical significance (2.6% vs 4.5%, P = 0.193). CONCLUSIONS Although acute hematologic toxicity was observed more frequently in the elderly patients than that in the younger patients, elderly rectal cancer patients with good performance status who received preoperative CRT and TME showed favorable tumor response and recurrence-free survival similar to younger patients.
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Son SM, Woo CG, Lee OJ, Lee SJ, Lee TG, Lee HC. Factors affecting retrieval of 12 or more lymph nodes in pT1 colorectal cancers. J Int Med Res 2019; 47:4827-4840. [PMID: 31495249 PMCID: PMC6833376 DOI: 10.1177/0300060519862055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to identify clinicopathological factors that affect the number of lymph nodes (LNs) (12 or more) retrieved from patients with colorectal cancer (CRC), particularly those with pathologic T1 (pT1) disease. Methods From 429 CRC patients, 75 pT1 cancers were identified and digitally scanned. Binary logistic regression analysis was performed to identify the clinicopathological factors affecting the number of LNs retrieved from all 429 patients and from the subset of patients with pT1 CRC. Results For the 429 patients, the mean number of harvested LNs per specimen was 20 (median, 19). The number of retrieved LNs was independently associated with maximum tumor diameter > 2.3 cm and right-sided tumor location. The mean number of LNs retrieved from the 75 patients with pT1 CRC was 14 (median, 15); retrieval of 12 or more LNs from this group was independently associated with maximum tumor diameter > 14.1 mm. Conclusion The number of LNs retrieved from patients with CRC was associated with maximum tumor diameter and right-sided tumor location. For patients with pT1 CRC, maximum tumor diameter was independently associated with the harvesting of 12 or more LNs.
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Affiliation(s)
- Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Chang Gok Woo
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ok-Jun Lee
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sang-Jeon Lee
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Taek-Gu Lee
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ho-Chang Lee
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Kim JS, Park WC, Lee JH. Comparison of Short-term Outcomes of Laparoscopic-Assisted Colon Cancer Surgery Using a Joystick-Guided Endoscope Holder (Soloassist II) or a Human Assistant. Ann Coloproctol 2019; 35:181-186. [PMID: 31487765 PMCID: PMC6732332 DOI: 10.3393/ac.2018.10.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Abstract
Purpose This study aimed to compare the short-term outcomes of laparoscopic-assisted colon cancer surgery in the Soloassist II-assisted (SA) group and in the human-assisted (HA) group. Methods A total of 76 patients with colon cancer who underwent laparoscopic-assisted right hemicolectomy and anterior resection performed by a single surgeon between January 2017 and May 2018 were recruited from the consecutively enrolled registry and retrospectively analyzed. Results Of 76 patients, 43 underwent surgery with human assistance and 33 underwent surgery using the Soloassist II system. The clinicopathologic characteristics were not statistically different between the 2 groups. In both HA and SA groups, no statistical difference was observed between operation time (220.23 ± 47.83 minutes vs. 218.03 ± 38.22 minutes, P = 0.829), total number of harvested lymph nodes (20.42 ± 10.86 vs. 20.24 ± 8.21, P = 0.938), and other parameters of short-term outcomes (length of hospital stay, blood loss, open conversion, time to flatus, time to soft diet, and complication events). Subgroup analyses did not show statistical differences. Conclusion Soloassist II can reduce the participation of a human assistant during surgery and is not inferior to human assistance in laparoscopic-assisted colon cancer surgery. Thus, it is a feasible instrument in laparoscopic-assisted colon cancer surgery that can provide positive short-term outcomes.
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Affiliation(s)
- Jun Sung Kim
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Cheol Park
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Joo Hyun Lee
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Xie X, Yin J, Zhou Z, Dang C, Zhang H, Zhang Y. Young age increases the risk for lymph node metastasis in patients with early Colon Cancer. BMC Cancer 2019; 19:803. [PMID: 31412872 PMCID: PMC6693219 DOI: 10.1186/s12885-019-5995-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 07/30/2019] [Indexed: 02/08/2023] Open
Abstract
Background The risk of lymph node positivity in early-stage colon cancer is a parameter that impacts therapeutic recommendations. However, little is known about the effect of age on lymph node positivity in colon cancer with mucosal invasion. In this study, we aimed to quantify the effect of younger age on lymph node positivity in colon cancer with mucosal invasion. Methods All patients were identified between 2004 and 2014 in the Surveillance, Epidemiology, and End Results database. Patients were stage T1-T2, did not undergo preoperative radiotherapy, had at least one lymph node examined, and underwent a standard colon cancer operation. Demographics and pathological data were compared between different age ranges. A nomogram model was built to estimate the probability of nodal involvement according to different characteristics. Decision curve analysis was performed by calculating the net benefits for a range of threshold probabilities. Results This study identified 41,490 patients who met the eligibility criteria for our study. 1.4% (n = 620) of patients were under 40 years old; 5.9% (n = 2571) were between 40 and 49 years old. Within each T stage, positive lymph node rates decreased with increasing age. In univariate analyses, the positive lymph node rates for patients 20 to 39 years of age were significantly higher than in patients in the reference group for stages T1 and T2. After dividing the colon into the left and right parts, these trends remained. The lymph node metastatic rate was higher in the right colon than in the left colon in terms of different age ranges. The nomogram prediction system represents a novel model with which to estimate lymph node metastasis in early T stage colon adenocarcinomas based on four risk factors with a C-index of 0.657 (95% CI: 0.658–0666). Conclusions Our study demonstrates that the risk of lymph node metastasis was higher in young (< 40 years) patients with early-stage colon adenocarcinomas. Therefore, more aggressive screening and therapeutic strategies should be considered for young patients with colon adenocarcinoma.
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Affiliation(s)
- Xin Xie
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jianhao Yin
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Zhangjian Zhou
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Chengxue Dang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hao Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Yong Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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