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Yao L, Shao H, Zhang X, Huang X. A novel risk model for predicting peritoneal metastasis in colorectal cancer based on the SEER database. J Cancer Res Clin Oncol 2023; 149:15989-16000. [PMID: 37679653 DOI: 10.1007/s00432-023-05368-9] [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: 06/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Early detection and intervention could significantly improve the prognosis of patients with peritoneal metastasis (PM). Our main purpose was to develop a model to predict the risk of PM in patients with colorectal cancer (CRC). METHODS Patients from the Surveillance, Epidemiology, and End Results (SEER) database with CRC classified according to the AJCC 8th TNM staging system were selected for the study. After data pre-processing, the dataset was divided into a training set and a validation set. In the training set, univariate logistic analysis and stepwise multivariate logistic regression analysis were utilized to screen clinical features and construct a risk prediction model. Then, we validated the model using the confusion matrix, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves to examine its performance. RESULTS The model constructed using stepwise multivariate logistic regression analysis incorporated the following eight clinical features: age, tumor location, histological type, T stage, carcinoembryonic antigen (CEA) level, tumor deposits (TDs), log odds (LODDS) of metastatic lymph nodes, and extraperitoneal metastasis (EM). The areas under the curve (AUCs) of the model in the training and validation sets were 0.924 and 0.912, respectively. The accuracy and the recall ratio were higher than 0.8 in both cohorts. DCA and the calibration curves also confirmed its excellent predictive power. CONCLUSIONS Our model can effectively predict the risk of PM in CRC patients, which is of great significance for the timely identification of patients at high risk of PM and further clinical decision-making.
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Affiliation(s)
- Li Yao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China
| | - Huan Shao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China
| | - Xinyi Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China
| | - Xuan Huang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China.
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2
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Dermody SM, McMichael BM, Bellile E, Marchiano EJ, Chinn SB. Lymph node level ratio as a predictor of survival in oral cavity squamous cell carcinoma. Oral Oncol 2023; 146:106572. [PMID: 37742470 DOI: 10.1016/j.oraloncology.2023.106572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To evaluate whether nodal yields and ratios based on level serves as prognostic indicators in patients with oral cavity squamous cell carcinoma undergoing neck dissection. MATERIALS AND METHODS A retrospective analysis of 342 patients with oral cavity squamous cell carcinoma treated surgically between 1998 and 2017 were included.Demographics and clinicopathologic data were collated. Disease specific survival and overall survival were analyzed via Kaplan-Meier method and log-rank test as well as univariable and multivariable Cox models. RESULTS Total nodal yield is associated with improved overall and disease specific survival (p < 0.01). Total positive nodal yield (p < 0.01), positive nodal ratio per level (p < 0.001), and identification of <4 lymph nodes/level (p < 0.001) are associated with worse disease specific survival and overall survival. A ratio of at least 4 lymph nodes/level dissected yields the maximal hazard ratio on for both disease specific and overall survival optimizes the Kaplan-Meier split between survival groups. After controlling for sex, age, margin status, disease stage, extranodal extension, perineural invasion, and lymphovascular invasion as fixed covariates in the Cox models, a nodal level ratio of 4 lymph nodes/level provides hazard ratio (95% CI) of 3.59 (1.69, 7.60); p < 0.0006) for disease free survival and 2.90 (1.54, 5.46; p < 0.001) for overall survival. CONCLUSION Nodal level ratio of < 4 lymph nodes/level is associated with worse disease specific and overall survival in oral cavity squamous cell carcinoma. This level-specific metric may prove useful qualitatively and in predicting survival in oral cavity cancer with broader utility to address variations in levels of neck dissection performed.
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Affiliation(s)
- Sarah M Dermody
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Brennan M McMichael
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Emily Bellile
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Emily J Marchiano
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
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3
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Li J, Xu Y, Zhang J, Wang S, Wang X, Guo H, Miao G. Prognostic value of the nodal yield in oral squamous cell carcinoma: a systematic review and meta-analysis. Expert Rev Anticancer Ther 2023; 23:339-345. [PMID: 36645663 DOI: 10.1080/14737140.2023.2168648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To systematically evaluate the prognostic value of the nodal yield in oral squamous cell carcinoma by meta-analysis. METHODS The meta-analysis was adherence to PRISMA. We searched MEDLINE, Embase, and Cochrane for studies published up to 20 April 2022. We collected evidences from observational studies regarding nodal yield in oral squamous cell carcinoma, and investigated its prognostic value by the routine methods of meta-analysis. RESULTS From seven studies, there was no significant impact of the lymph node yield on overall survival among patients with oral squamous cell carcinoma cases and <18 lymph nodes (hazard ratio (HR) = 1.019, 95% confidence interval (CI) = 0.786-1.320, p = 0.887), with significant heterogeneity (I2 = 80%). The pooled result indicated that a > 18-lymph node yield was a favorable prognostic factor (HR = 0.786, 95%CI = 0.646-0.956, p = 0.016; I2 = 39%). The lymph node yield was not associated with disease-specific survival (HR = 1.594, 95%CI = 0.996-2.552, p = 0.052; I2 = 81%) or disease-free survival (HR = 1.508, 95%CI = 0.924-2.460, p = 0.100; I2 = 41%). CONCLUSION A lymph node yield of ≥18 lymph nodes might be a favorable prognostic factor for the overall survival of patients with oral squamous cell carcinoma.
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Affiliation(s)
- Jiajia Li
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Yubo Xu
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Shaohai Wang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Xiaoyu Wang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Huayan Guo
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Guojun Miao
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
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Long-term oncologic outcome of D3 lymph node dissection for clinical stage 2/3 right-sided colon cancer. Int J Colorectal Dis 2023; 38:42. [PMID: 36790520 DOI: 10.1007/s00384-023-04310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To investigate oncologic outcomes including overall survival and disease-free survival depending on the extent of lymphadenectomy (D3 versus D2) by comparing D3 and D2 lymphadenectomy in patients with clinical stage 2/3 right colon cancer. METHODS Consecutive series of patients who underwent radical resection for right colon cancer at our three hospitals between January 2015 and June 2018 were retrospectively analyzed. Study cohorts were divided into two groups: D3 group and D2 group. Oncologic, pathologic, and perioperative outcomes of the two groups were compared. RESULTS A total of 295 patients (167 in the D2 group and 128 in the D3 group) were included in this study. Patients' characteristics showed no significant difference between the two groups. The median number of harvested lymph nodes was significantly higher in the D3 group than in the D2 group. The rate of complications was not significantly different between the two groups except for chyle leakage, which was more frequent in the D3 group. Five-year disease-free survival was 90.2% (95% CI: 84.8-95.9%) in the D3 group, which was significantly (p = 0.028) higher than that (80.5%, 95% CI: 74-87.5%) in the D2 group. There was no significant difference in overall survival between the two groups. CONCLUSION Our results indicate that D3 lymphadenectomy is associated with more favorable 5-year disease-free survival than D2 lymphadenectomy for patients with stage 2/3 right-sided colon cancer. D3 lymphadenectomy might improve oncologic outcomes in consideration of the recurrence rate.
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5
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Hayes IP, Milanzi E, Gibbs P, Faragher I, Reece JC. Is increasing nodal count associated with improved recurrence-free and overall survival following standard right hemicolectomy for cancer? J Surg Oncol 2022; 126:523-534. [PMID: 35481710 PMCID: PMC9544048 DOI: 10.1002/jso.26913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/12/2022]
Abstract
Background and Objectives Increasing lymph node harvest for right‐sided colon cancer is associated with improved overall survival (OS), but most relevant studies failed to report the extent of resection. We examined the association between increasing lymph node count with standard right hemicolectomy according to nodal status and prognostic outcomes in right‐sided tumors. Methods Retrospective analysis of prospectively collected clinical data from patients with proximal colonic adenocarcinomas (n = 1390) following right hemicolectomy. Associations between lymph node counts (0–12 vs. 13–15, 16–20, and >20) and recurrence‐free survival (RFS) and OS were examined using multivariate Cox modeling adjusted for confounders. Results We found no association between increasing nodal count and RFS, regardless of nodal status. In the absence of nodal metastases, increasing nodal count (16–20 and >20 vs. 0–12 nodes) was associated with 57% (95% confidence interval [CI]: 0.21–0.89) and 52% (95% CI: 0.24–0.95) improved OS, respectively. In the presence of nodal metastases, increasing nodal count was not associated with OS. Adjuvant chemotherapy did not modify this effect. Conclusion Increasing nodal count (>15 nodes) with right hemicolectomy was not associated with improved RFS. Improved OS was only found for node‐negative tumors, casting some doubt on the benefits of resecting more lymph nodes in the presence of nodal metastases.
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Affiliation(s)
- Ian P Hayes
- Colorectal Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elasma Milanzi
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Peter Gibbs
- Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia
| | - Ian Faragher
- Colorectal Surgery, Western Health, Melbourne, Victoria, Australia
| | - Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.,The University of Melbourne Centre for Cancer Research, The University of Melbourne, Melbourne, Victoria, Australia
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6
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Pei JP, Zhang R, Zhang NN, Zeng YJ, Sun Z, Ma SP, Zhou JG, Li XX, Fan J, Zhu J, Abe M, Mei ZB, Shi G, Zhang CD. Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1513. [PMID: 34790719 PMCID: PMC8576719 DOI: 10.21037/atm-21-3170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/27/2021] [Indexed: 11/06/2022]
Abstract
Background Lymph node ratio (LNR) has advantages in predicting prognosis compared with American Joint Committee on Cancer (AJCC) pathological N stage. However, the prognostic value of a novel T stage-lymph node ratio (TLNR) classification for colon cancer combining LNR and pathological primary tumor stage (T stage) is currently unknown. Methods We included 62,294 patients with stage I-III colon cancer from the Surveillance, Epidemiology, and End Results Program as a training cohort. External validation was performed in 3,327 additional patients. A novel LNR stage was established and combined with T stage in a novel TLNR classification. Patients with similar survival were grouped according to T and LNR stages, with T1LNR1 as a reference. Results We developed a novel TLNR classification as follows: stages I (T1LNR1-2, T1LNR4), IIA (T1LNR3, T2LNR1-2, T3LNR1), IIB (T1LNR5, T2LNR3-4, T3LNR2, T4aLNR1), IIC (T2LNR5, T3LNR3-4, T4aLNR2, T4bLNR1), IIIA (T3LNR5, T4aLNR3-4, T4bLNR2), IIIB (T4aLNR5, T4bLNR3-4), and IIIC (T4bLNR5). In the training cohort, the novel TLNR classification had better prognostic discrimination (area under receiver operating characteristic curve, 0.621 vs. 0.608, two-sided P<0.001), superior model-fitting ability for predicting overall survival (Akaike information criteria, 561,129 vs. 562,052), and better net benefits compared with the AJCC 8th tumor/node/metastasis classification. Similar results were found in the validation cohort for predicting both overall and disease-free survival. Conclusions This novel TLNR classification may provide better prognostic discrimination, model-fitting ability, and net benefits than the AJCC 8th TNM classification, for potentially better stratification of patients with operable stage I-III colon cancer; however, further studies are required to validate the novel TLNR classification.
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Affiliation(s)
- Jun-Peng Pei
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Rui Zhang
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Nan-Nan Zhang
- State key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Yong-Ji Zeng
- Eppley Institute for Research in Cancer, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Zhe Sun
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Si-Ping Ma
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Jian-Guo Zhou
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin-Xiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Ji Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Masanobu Abe
- Division for Health Service Promotion, The University of Tokyo, Tokyo, Japan
| | - Zu-Bing Mei
- Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Gang Shi
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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7
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Saleem AM, Saber W, Alnajashi RA, Alamoudi EA, Shilli YH, Aljabarti AM, Al-Hajeili M. Outcomes of Non-metastatic Colon Cancer: A Single-Center Experience. Cureus 2021; 13:e17657. [PMID: 34659935 PMCID: PMC8491801 DOI: 10.7759/cureus.17657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 12/09/2022] Open
Abstract
Background Colorectal cancer (CRC) is the most common gastrointestinal cancer. In the Saudi Cancer Registry, CRC ranked as the most common cancer in men and the third most common cancer in women. Data regarding the stage of CRC at presentation and patient demographics and outcomes in Saudi Arabia are lacking. This study aimed to investigate the prevalence, survival, and mortality rates of patients with non-metastatic CRC in a tertiary care hospital in Saudi Arabia. Methods We conducted a retrospective chart review of patients diagnosed with adenocarcinoma of the colon or rectum at King Abdulaziz University Hospital between 2013 and 2017. Patients aged ≥18 years who presented with non-metastatic CRC and underwent curative resection were included. Patients with rectal cancer or metastatic colon cancer were excluded. Data on demographic characteristics, histopathological findings, tumor-node-metastasis stage, biomarkers, and surgical interventions were collected. Recurrence-free survival was defined as the time from surgery to the date of recurrence or death. All statistical analyses were performed using Stata/IC 15.1 (StataCorp, College Station, TX, USA). Results Among 260 patients diagnosed with CRC, 82 were included based on the inclusion/exclusion criteria. Among those patients, 65.9% were men and 47.5% were Saudi citizens. The mean age at the time of diagnosis was 60.8 years. Fifty-three patients (64.6%) had left-sided colon cancer. The mean tumor diameter was 52.6 mm. Most colon tumors were T3 lesions (71.3%), and 41% of patients did not have lymph node involvement (N0). Most patients (85.1%) underwent open surgery. In the multivariate analysis, only resection margin status and N stage (hazard ratio: 17.7 and 3.7, respectively) were identified as statistically significant factors affecting the recurrence-free survival. The one-, two-, and five-year recurrence-free rates were 80.5%, 66.5%, and 57.1%, respectively, and the one-, two-, and five-year and overall survival rates were 90.3%, 82.5%, and 82.5%, respectively. Conclusions We showed significant reductions in recurrence-free and overall survival within the first two years after surgical resection. Further prospective studies are needed to explore predictors.
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Affiliation(s)
| | - Wafa Saber
- Internal Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | | | - Ebtihal A Alamoudi
- Internal Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | | | - Amani M Aljabarti
- Internal Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Marwan Al-Hajeili
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Żok J, Bieńkowski M, Radecka B, Korniluk J, Adamowicz K, Duchnowska R. Impact of relative dose intensity of oxaliplatin in adjuvant therapy among stage III colon cancer patients on early recurrence: a retrospective cohort study. BMC Cancer 2021; 21:529. [PMID: 33971834 PMCID: PMC8112028 DOI: 10.1186/s12885-021-08183-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 04/13/2021] [Indexed: 02/04/2023] Open
Abstract
Background Oxaliplatin-based therapy with FOLFOX-4 or CAPOX administered over 6 months remains the standard adjuvant treatment for stage III colon cancer (CC) patients. However, many patients experience dose reduction or early termination of chemotherapy due to oxaliplatin toxicity, which may increase the risk of early recurrence. The objective of this study was to analyze the relationship between the relative dose intensity of oxaliplatin (RDI-O) and early recurrence among stage III CC patients. Methods The study included 365 patients treated at five oncology centers in Poland between 2000 and 2014. Survival analysis was performed using the Kaplan-Meier method. Univariate analysis was performed using the Cox proportional hazard model; multivariate analysis was performed with the stepwise forward approach. For all analyses the α level of 0.05 was employed. Results The median follow-up was 51.8 months (range 8.2–115.1). Early recurrence < 36 months after surgery occurred in 130 patients (37.8%). In this group 51 (39.2%) and 87 (66.9%) of patients were low and high-risk, respectively. Receipt < 60% of RDI-O was associated with early recurrence within 18 months after surgery (OR = 2.05; 95%CI: 1.18–3.51; p = 0.010), especially in low-risk group (HR = 1.56 (95%CI: 0.96–2.53), p = 0.07). In the multivariate analysis early recurrence was correlated with grade (OR = 2.47; 95% CI: 1.25–4.8; p = 0.008), pN (OR = 2.63; 95% CI: 1.55–4.54; p < 0.001), the number of lymph nodes harvested (OR = 0.51; 95% CI: 0.29–0.86; p = 0.013) and RDI-O (OR = 1.91; 95%CI: 1.06–3.39; p = 0.028). The early vs. late recurrence negatively correlated with OS regardless of the RDI-O (HR = 22.9 (95%CI: 13.9–37.6; p < 0.001). Conclusions RDI-O < 60% in adjuvant therapy among stage III CC (especially in low-risk group) increases the risk of early recurrence within 18 months of surgery. Patients with early recurrence showed worse overall survival regardless of the RDI-O.
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Affiliation(s)
- Jolanta Żok
- Department of Chemotherapy, Center of Pulmonology and Chemotherapy, 58-580, Szklarska Poręba, Poland
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdańsk, 80-214, Gdańsk, Poland
| | - Barbara Radecka
- Department of Oncology, Institute of Medical Science, University of Opole, 46-020, Opole, Poland
| | - Jan Korniluk
- Department of Oncology, Military Institute of Medicine, 04-141, Warsaw, Poland
| | | | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, 04-141, Warsaw, Poland.
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Lymph Node Yield and Ratio in Selective and Modified Radical Neck Dissection in Head and Neck Cancer-Impact on Oncological Outcome. Cancers (Basel) 2021; 13:cancers13092205. [PMID: 34064344 PMCID: PMC8125696 DOI: 10.3390/cancers13092205] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/25/2021] [Accepted: 05/02/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Lymph node metastases are associated with poor prognosis in head and neck squamous cell carcinoma (HNSCC). Neck dissection (ND) is often performed prior to or after (chemo)radiation (CRT) and is an integral part of HNSCC treatment strategies. The impact of CRT delivered prior to ND on lymph node yield (LNY) and lymph node ratio (LNR) has not been comprehensively investigated. Material and methods: A retrospective cohort study was conducted from January 2014 to 30 June 2019 at the University Hospital of Bern, Switzerland. We included 252 patients with primary HNSCC who underwent NDs either before or after CRT. LNY and LNR were compared in patients undergoing ND prior to or after CRT. A total of 137 and 115 patients underwent modified radical ND (levels I to V) and selective ND, respectively. The impact of several features on survival and disease control was assessed. Results: Of the included patients, 170 were male and 82 were females. There were 141 primaries from the oral cavity, 55 from the oropharynx, and 28 from the larynx. ND specimens showed a pN0 stage in 105 patients and pN+ in 147. LNY, but LNR was not significantly higher in patients undergoing upfront ND than in those after CRT (median: 38 vs. 22, p < 0.0001). Cox hazard ratio regression showed that an LNR ≥ 6.5% correlated with poor overall (HR 2.42, CI 1.12-4.89, p = 0.014) and disease-free survival (HR 3.416, CI 1.54-754, p = 0.003) in MRND. Conclusion: ND after CRT leads to significantly reduced LNY. An LNR ≥6.5% is an independent risk factor for decreased overall, disease-free, and distant metastasis-free survival for MRND.
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10
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Technical considerations depending on the level of vascular ligation in laparoscopic rectal resection. Surg Endosc 2021; 36:1961-1969. [PMID: 33876306 DOI: 10.1007/s00464-021-08479-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
AIM In addition to ischemia there is also anastomotic ends tension proven to be a risk factor for anastomotic leak. HT vascular ligation is accepted as a rule, in attempt to achieve tension-free anastomosis. LT is a preferred option, based on the more accurate preservation of proximal intestinal segment microperfusion and lower risk of damage to the hypogastric plexus. The aim of this study is evaluation of comparative indicators in high tie (HT) and low tie (LT) laparoscopic rectal resections. METHODS A prospective nonrandomized comparative cohort study of patients in our department with cancer of the rectum in clinical stage I-III, operated on in laparoscopic approach over a 6-years period. RESULTS For the period 2015-2020, a number of 208 laparoscopic surgeries have been done for rectal cancer. Patients were divided into three groups-group A with HT vascular ligation 116 pts. (69%), group B-53 pts. (25%), underwent low ligation-LT and group C-39pts. (19%) low tie plus lymph node dissection of the apical LN group (LT-appic LND). The distribution was made without randomization, based on the operators' expertise. Anastomotic leaks were 3.8% in group A, 3.0% in group B and 2.9% in group C (p > 0.05) with no significance difference. There is no significant difference in the number of lymph nodes obtained in group A and group B, while in group C the number of the harvested lymph nodes was higher (p < 0.05). The indicators for intestinal / defecation dysfunction, as well as for urinary/sexual dysfunction, according to our data, are significantly more favorable in patients with LT, in contrast to the other two groups. CONCLUSION HT vascular ligation attempts to achieve tension-free anastomosis and more harvested lymph nodes. However, LT could be a preferred option, based on the lack of significant evidence for a difference in specific oncological survival and due to more accurate preservation of proximal intestinal segment microperfusion to prevent anastomosis dehiscence, also for its lower risk of damage to the hypogastric plexus. Splenic flexure mobilization provides elongation of the proximal intestinal segment, but has no proven effect on anastomotic leakage incidence. It increases surgical duration and is in fact necessary in up to 30% of the cases. At the present moment there is no precise data whether LT has an advantage in terms of prevention of autonomic nervous and urogenital dysfunction. New prospective randomized and highly probative studies are needed to standardize the procedures in specific clinical situations.
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Survival rates and prognostic factors in right- and left-sided colon cancer stage I-IV: an unselected retrospective single-center trial. Int J Colorectal Dis 2021; 36:2683-2696. [PMID: 34436692 PMCID: PMC8589737 DOI: 10.1007/s00384-021-04005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors. METHODS In total, 417 patients with colon cancer stage I-IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan-Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model. RESULTS Our study showed no significant difference of the overall survival between rCC and lCC stage I-IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1-123.5), CEA (carcinoembryonic antigen) blood level > 100 µg/l (HR: 3.3; CI 95%: 1.2-9.0), increased lymph node ratio of 0.6-1.0 (HR: 5.3; CI 95%: 1.7-16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7-2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9-91.9), CEA blood level 20.1-100 µg/l (HR: 5.4; CI 95%: 2.4-12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0-49.0), and severe surgical complications (Clavien-Dindo III-IV) (HR: 2.9; CI 95%: 1.5-5.5) were identified as predictors of a diminished overall survival. CONCLUSION Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients.
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Ramachandra C, Sugoor P, Karjol U, Arjunan R, Altaf S, Patil V, Kumar H, Beesanna G, Abhishek M. Robotic Complete Mesocolic Excision with Central Vascular Ligation for Right Colon Cancer: Surgical Technique and Short-term Outcomes. Indian J Surg Oncol 2020; 11:674-683. [PMID: 33281407 PMCID: PMC7714811 DOI: 10.1007/s13193-020-01181-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Minimally invasive colorectal surgery has demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. PURPOSE The study aims to present technical details and short-term oncological outcomes of robotic-assisted complete mesocolic excision (CME) with central vascular ligation (CVL) for right colon cancer. METHODOLOGY Fifty-two consecutive patients affected by right colon cancer were operated between May 2016 and February 2020 with da Vinci Xi platform. Data regarding surgical and short-term oncological outcomes were systematically collected in a colorectal specific database for statistical analysis. RESULTS Thirty-seven (71.15%) and 15 (28.85%) patients underwent right and extended right hemicoletomy with an extracorporeal anastomosis. Median age was 55 years. Mean operative time was 182 ± 36 min. Mean blood loss was 110 ± 90 ml. Conversion rate was 3.84% (two cases). 78.84% (41 cases) were pT3 and mean number of harvested lymph nodes was 28 ± 4. 1/52 (1.92%) had a documented anastomotic leak requiring exploratory laparotomy and diversion proximal ileostomy. Surgery-related grade IIIa-IIIb Calvien Dindo morbidity were noted in 9.61% and 1.92%, respectively. CONCLUSION Robotic assistance allows performance of oncological adequate dissection of the right colon with radical lymphadenectomy as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.
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Affiliation(s)
- C. Ramachandra
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Uday Karjol
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Syed Altaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Vijay Patil
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Harish Kumar
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - G. Beesanna
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - M. Abhishek
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
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Azin A, Hirpara DH, Draginov A, Khorasani M, Patel SV, O'Brien C, Quereshy FA, Chadi SA. Adequacy of lymph node harvest following colectomy for obstructed and nonobstructed colon cancer. J Surg Oncol 2020; 123:470-478. [PMID: 33141434 DOI: 10.1002/jso.26274] [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] [Received: 08/24/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Technical and clinical differences in resection of obstructed and non-obstructed colon cancers may result in differences in lymph node retrieval. The objective of this study is to compare the lymph node harvest following resection of obstructed and nonobstructed colon cancer patients. METHODS A retrospective analysis utilizing the 2014-2018 NSQIP colectomy targeted data set was conducted. One-to-one coarsened exact matching (CEM) was utilized between patients undergoing resection for obstructed and non-obstructed colon cancer. The primary outcome was the adequacy of lymph node retrieval (LNR, ≥12 nodes). RESULTS CEM resulted in 9412 patients. Patients with obstructed tumors were more likely to have inadequate LNR (13.3% vs 8.2%, p < .001) compared to those with nonobstructed tumors. Multivariate analysis demonstrated that patients with obstructing tumors had worse LNR compared to non-obstructed tumors (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.62-0.87; p < .005). Increased age (OR: 0.99, 95% CI: 0.098-0.99), presence of preoperative sepsis (OR: 0.70, 95% CI: 0.055-0.90), left-sided and sigmoid tumors compared to right-sided (OR: 0.64, 95% CI: 0.51-0.81; OR: 0.69, 95% CI: 0.58-0.82, respectively), and open surgical resection compared to an minimally invasive surgical approach were associated with inadequate LNR (p < .05). CONCLUSION This study demonstrated that resection for obstructing colon cancer compared to non-obstructed colon cancer is associated with increased odds of inadequate lymph node harvest.
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Affiliation(s)
- Arash Azin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arman Draginov
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Sunil V Patel
- Division of General Surgery, Queens University, Kingston, Ontario, Canada
| | - Catherine O'Brien
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sami A Chadi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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14
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Yu Y, Sultana R, Rangabashyam MS, Mohan N, Hwang JSG, Soong YL, Tan NC, Iyer GN, Tan HK. Impact of Radiotherapy on Neck Dissection Nodal Count in Patients With Head and Neck Cancer. Laryngoscope 2020; 130:1947-1953. [PMID: 32401396 DOI: 10.1002/lary.28620] [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: 08/28/2019] [Revised: 02/05/2020] [Accepted: 02/25/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our study aimed to review the impact of preoperative radiotherapy (RT) and other factors on the lymph node count of neck dissection (ND) specimens from patients with head and neck cancer (HNC). A retrospective study was conducted on all patients with head and neck cancers who had undergone NDs in Singapore General Hospital between 1992 and 2013. STUDY DESIGN Retrospective study. METHODS Patients were categorized into two groups: patients treated with RT with or without chemotherapy before ND and patients who had undergone ND surgery without previous history of RT. The primary endpoint for this study would be the lymph node count from ND. RESULTS The study cohort consists of 1,024 NDs on 829 patients. There were 597 (58.3%) radical/modified radical NDs involving levels I-V. Within this group, 75 (12.6%) NDs had preoperative RT. Preoperative RT and age were found to significantly reduce nodal yield in both univariate and multivariate analysis in the radical/modified radical ND subgroup. In our multivariate analysis, preoperative RT was shown to decrease the nodal yield by 7.464 (P = .0002, 95% confidence interval [CI]: -11.35 to -3.58). Advanced age independently decreases nodal yield, even after accounting for the effect of RT (P = .0002, 95% CI: -0.27 to -0.08). In addition, preoperative RT has a more pronounced effect in reducing lymph node count in the older age group. CONCLUSIONS Preoperative RT and advanced age are independent and synergistic factors that reduce nodal count from NDs in patients with head and neck cancers. LEVEL OF EVIDENCE 4 Laryngoscope, 130: 1947-1953, 2020.
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Affiliation(s)
- Yue Yu
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Mahalakshmi S Rangabashyam
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore
| | - Niraj Mohan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | | | - Yoke-Lim Soong
- SingHealth Duke-NUS Head and Neck Centre, Singapore.,Division of Radiation Oncology, National Cancer Centre, Singapore
| | - Ngian-Chye Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Gopalakrishna N Iyer
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Hiang-Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
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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: 17] [Impact Index Per Article: 4.3] [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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16
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Zhang QW, Zhang CH, Pan YB, Biondi A, Fico V, Persiani R, Wu S, Gao YJ, Chen HM, Shi OM, Ge ZZ, Li XB. Prognosis of colorectal cancer patients is associated with the novel log odds of positive lymph nodes scheme: derivation and external validation. J Cancer 2020; 11:1702-1711. [PMID: 32194782 PMCID: PMC7052858 DOI: 10.7150/jca.38180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/10/2019] [Indexed: 01/16/2023] Open
Abstract
Background and aim: To construct proper and externally validate cut-off points for log odds of positive lymph nodes scheme (LODDS) staging scheme in colorectal cancer (CRC). Patients and methods: The X-tile approach was used to find the cut-off points for the novel LODDS staging scheme in 240,898 patients from the Surveillance, Epidemiology and End Results (SEER) database and externally validated in 1,878 from the international multicenter cohort. Kaplan-Meier plot and multivariate Cox proportional hazard models were performed to investigate the role of the novel LODDS classification. Results: The prognostic cut-off values were determined as -2.18, and -0.23 (P< 0.001). Patients had 5-year cancer-specific survival rates of 83.8%, 57.4% and 24.4% with increasing LODDS (P< 0.001) in the SEER database. Five-year overall survival rates were 77.2%, 55.0% and 26.7% with increasing LODDS (P< 0.001) in the external international multicenter cohort. Multivariate survival analysis identified both the LODDS classification, the patient's age, the T category, the M status, and the tumor grade as independent prognostic factors in both two independent databases. The analyses of the subgroup of patients stratified by tumor location (colon or rectum), number of retrieved lymph node (< 12 or ≥ 12), TNM stage III, lymph node-negative also confirmed the LODDS as independent prognostic factors (P< 0.001) in both two independent databases. Conclusions: The novel LODDS classification was an independent prognostic factor for patients with CRCs and should be calculated for additional risk group stratification with pN scheme.
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Affiliation(s)
- Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Chi-Hao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China
| | - Yuan-Bo Pan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Alberto Biondi
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Roma, Italy Largo F. Vito, 100168 Rome, Italy
| | - Valeria Fico
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Roma, Italy Largo F. Vito, 100168 Rome, Italy
| | - Roberto Persiani
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Roma, Italy Largo F. Vito, 100168 Rome, Italy
| | - Shan Wu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yun-Jie Gao
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Hui-Min Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Ou-Min Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, South Chongqing Road No, Shanghai 227, China
| | - Zhi-Zheng Ge
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiao-Bo Li
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
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Manceau G, Voron T, Mege D, Bridoux V, Lakkis Z, Venara A, Beyer-Berjot L, Abdalla S, Sielezneff I, Lefèvre JH, Karoui M. Prognostic factors and patterns of recurrence after emergency management for obstructing colon cancer: multivariate analysis from a series of 2120 patients. Langenbecks Arch Surg 2019; 404:717-729. [PMID: 31602503 DOI: 10.1007/s00423-019-01819-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE At equal TNM stage, obstructing colon cancer (OCC) is associated with worse prognosis in comparison with uncomplicated cancer. Our aim was to identify prognostic factors of overall (OS) and disease-free survival (DFS) in patients treated for OCC. METHODS From 2000 to 2015, 2325 patients were treated for OCC in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management were excluded. The main endpoints were OS and DFS. A multivariate analysis, using Cox proportional hazards regression model, was performed to determine independent prognostic factors. RESULTS The cohort included 2120 patients. The median of follow-up was 13.2 months. In multivariate analysis, age > 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, presence of synchronous metastases, anastomotic leakage, and absence of adjuvant chemotherapy were independent OS factors. Age > 75 years, ASA score ≥ 3, right-sided colon cancer, presence of synchronous metastases, and absence of postoperative chemotherapy were independent factors of poor OS after exclusion of patients who died postoperatively. Age ≥ 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, lymph node involvement, presence of vascular, lymphatic or perineural invasion, less than 12 harvested lymph nodes, and absence of adjuvant chemotherapy were independent DFS factors. CONCLUSIONS Management of OCC should take into account prognostic factors related to the patient (age, comorbidities), tumor location, and tumor stage. Adjuvant chemotherapy administration plays an important role. For patients undergoing initial defunctionning stoma, neoadjuvant chemotherapy could be an option to improve prognosis.
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Affiliation(s)
- Gilles Manceau
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Pitié Salpêtrière University Hospital, Paris, France
| | - Thibault Voron
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Saint Antoine University Hospital, Department of Digestive Surgery, Paris, France
| | - Diane Mege
- Timone University Hospital, Department of Digestive Surgery, Marseille, France
| | - Valérie Bridoux
- Charles Nicolle University Hospital, Department of Digestive Surgery, Rouen, France
| | - Zaher Lakkis
- Besançon University Hospital, Department of Digestive Surgery, Besançon, France
| | - Aurélien Venara
- Angers University Hospital, Department of Digestive Surgery, Angers, France
| | - Laura Beyer-Berjot
- Assistance Publique Hôpitaux de Marseille, North University Hospital, Department of Digestive Surgery, Marseille, France
| | - Solafah Abdalla
- Université Paris-Sud, Assistance Publique Hôpitaux de Paris, Bicêtre University Hospital, Department of Digestive Surgery, Le Kremlin Bicêtre, France
| | - Igor Sielezneff
- Timone University Hospital, Department of Digestive Surgery, Marseille, France
| | - Jeremie H Lefèvre
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Saint Antoine University Hospital, Department of Digestive Surgery, Paris, France
| | - Mehdi Karoui
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Pitié Salpêtrière University Hospital, Paris, France.
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Gumus M, Yumuk PF, Atalay G, Aliustaoglu M, Macunluoglu B, Dane F, Caglar H, Sengoz M, Turhal S. What is the Optimal Number of Lymph Nodes to be Dissected in Colorectal Cancer Surgery? TUMORI JOURNAL 2019; 91:168-72. [PMID: 15948546 DOI: 10.1177/030089160509100212] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Regional lymph node (LN) involvement in colorectal cancer (CRC) identifies the stage and the subset of patients who would benefit from adjuvant chemotherapy. We performed a retrospective analysis to determine if the number of recovered LNs was associated with long-term outcome in patients operated on for stage II and III CRC. Patients and methods Hospital records of 179 patients with CRC followed in our unit from 1997 to April 2003 were reviewed. Results On average 11.68 ± 7.3 LNs were sampled per surgical specimen. Sampling of at least nine LNs appeared to be the minimum number required for accurately predicting LN involvement ( P = 0.002). Three-year rates of disease-free survival (DFS), local recurrence-free survival (LRFS) and overall survival (OS) were lower in patients with fewer than nine LNs sampled ( P = 0.032, P = 0.006 and P = 0.04, respectively). However, this had no impact on the three-year distant metastasis-free survival rate (DMFS) ( P = 0.472). In stage II disease, patients with nine or more LNs dissected had significantly higher three year DFS and LRFS rates than the subgroup with fewer than nine LNs dissected ( P = 0.024 and P = 0.015, respectively), but this did not have any effect on DMFS or OS ( P = 0.406 and P = 0.353, respectively). Conclusion Current protocols provide adjuvant treatment in stage III patients; the problem is to correctly determine stage by recovering as many LNs as possible.
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Affiliation(s)
- Mahmut Gumus
- Oncology Division, Department of Internal Medicine, Marmara University Hospital, Istanbul, Turkey.
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Kataoka K, Ysebaert H, Shiozawa M, Reynders D, Ikeda M, Tomita N, Goetghebeur E, Ceelen W. Prognostic significance of number versus location of positive mesenteric nodes in stage iii colon cancer. Eur J Surg Oncol 2019; 45:1862-1869. [PMID: 31153766 DOI: 10.1016/j.ejso.2019.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/29/2019] [Accepted: 05/20/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Debate persists on the ideal extent of lymphadenectomy for colon cancer (CC). Specifically, it is unknown whether the anatomical location of positive lymph nodes (LN) has any independent prognostic significance. We assessed the prognostic value of positive LN location in stage III CC patients who underwent extensive (D3) lymphadenectomy. METHODS Patients from Kanagawa Cancer Center, Japan, who underwent D3 dissection for CC from 2000 to 16 were analyzed. Mesenteric LN were classified according to location as paracolic (L1), intermediate (L2), or central (L3). Recurrence-free survival (RFS) and the corresponding hazard function were evaluated with their trends over the L groups. Multivariate Cox models were used to evaluate the association of LN location with RFS. RESULTS Four hundred forty-six stage III patients were analyzed. The mean number of examined/positive nodes per patient was 42.5/2.6 in L1 (n = 310), 40.9/4.8 in L2 (n = 111), and 44.0/9.8 in L3 (n = 25). RFS was worse for L3 vs. L2 (HR: 2.00, 95%CI [1.05-3.75], p = 0.034) and for L3 vs. L1 (2.62 [1.45-4.71], p = 0.001), but not significantly different between L2 and L1 (1.32 [0.89-1.5], p = 0.17). In a multivariate model adjusting for age, tumor size, and number of lymph nodes harvested T-stage (p < 0.001), adjuvant therapy (p < 0.0038), lymphatic invasion (p = 0.023), and LNR (p = 0.038) were significantly associated with RFS, but not L level or tumor location. CONCLUSION The anatomical location of invaded LN does not significantly correlate with RFS in CC, after adjusting for potential confounders. Central LN are infrequently invaded and confer a worse RFS.
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Affiliation(s)
- Kozo Kataoka
- Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan; Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Japan.
| | - Hannes Ysebaert
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Japan
| | - Dries Reynders
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Masataka Ikeda
- Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan
| | - Naohiro Tomita
- Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Belgium
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de Kort WWB, Maas SLN, Van Es RJJ, Willems SM. Prognostic value of the nodal yield in head and neck squamous cell carcinoma: A systematic review. Head Neck 2019; 41:2801-2810. [PMID: 30969454 PMCID: PMC6767522 DOI: 10.1002/hed.25764] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Literature analysis on the prognostic factor of the nodal yield (NY) in neck dissections (NDs), which in general surgical oncology is a strong prognosticator and quality‐of‐care marker. Methods We performed a systematic review of all PubMed and Embase publications until June 30, 2018 screening for data on NY as prognosticator and overall survival (OS) as outcome in patients with head and neck squamous cell carcinoma (HNSCC). Risk for bias was asserted by application of the Quality In Prognosis Studies tool. Results Of the 823 screened publications, 15 were included in this analysis. Five out of seven that compared NY ≥18 vs <18 as prognosticator, showed significantly improved survival if NY ≥18. Six studies used other cutoffs and three reported improved survival with each additionally harvested lymph node. Conclusion Increased NY in ND specimen for HNSCC, most commonly described as ≥18 lymph nodes, is associated with improved OS and could be used as a prognosticator and quality‐of‐care marker.
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Affiliation(s)
- Willem W B de Kort
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sybren L N Maas
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J Van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Reddavid R, Esposito L, Evangelista A, Sofia S, Degiuli M. Non-anatomical colonic resections: splenic flexure and transverse colectomy. Central vascular ligation is crucial for survival. MINERVA CHIR 2019; 74. [DOI: 10.23736/s0026-4733.18.07803-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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22
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Zhang CH, Li YY, Zhang QW, Biondi A, Fico V, Persiani R, Ni XC, Luo M. The Prognostic Impact of the Metastatic Lymph Nodes Ratio in Colorectal Cancer. Front Oncol 2018; 8:628. [PMID: 30619762 PMCID: PMC6305371 DOI: 10.3389/fonc.2018.00628] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/03/2018] [Indexed: 01/13/2023] Open
Abstract
Background: This study was designed to validate the prognostic significance of the ratio of positive to examined lymph nodes (LNR) in patients with colorectal cancer. Methods: 218,314 patients from the SEER database and 1,811 patients from the three independent multicenter were included in this study. The patients were divided into 5 groups on a basis of previous published LNR: LNR0, patients with no metastatic lymph nodes; LNR1, patients with the LNR between 0.1 and 0.17; LNR2, patients with the LNR between 0.18 and 0.41; LNR3, patients with the LNR between 0.42 and 0.69; LNR4, patients with the LNR >0.7. The 5-year OS and CSS rate were estimated using Kaplan-Meier method and the survival difference was tested using log-rank test. Multivariate Cox analysis was used to further assess the influence of the LNR on patients' outcome. Results: The 5-year OS rate of patients within LNR0 to LNR4 group was 71.2, 55.8, 39.3, 22.6, and 14.6%, respectively (p < 0.001) in the SEER database. While the 5-year OS rate of those with LNR0 to LNR4 was 75.2, 66.1, 48.0, 34.0, and 17.7%, respectively (p < 0.001) in the international multicenter cohort. In the multivariate analysis, LNR was demonstrated to be a strong prognostic factor in patients with < 12 and ≥12 metastatic lymph nodes. Furthermore, the LNR had a similar impact on the patients' prognosis in colon cancer and rectal cancer. Conclusion: The LNR allowed better prognostic stratification than the positive node (pN) in patients with colorectal cancer and the cut-off values were well validated.
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Affiliation(s)
- Chi-Hao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Yan Li
- Department of Radiation Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Alberto Biondi
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Fico
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Persiani
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xiao-Chun Ni
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Luo
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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23
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Comment on "Impact of the Primary Tumor Location on the Prognosis for Colon Cancer: Adjustment for Bias Could Lead to Other Conclusions". Ann Surg 2018; 270:e38-e39. [PMID: 30480559 DOI: 10.1097/sla.0000000000003099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Manceau G, Mori A, Bardier A, Augustin J, Breton S, Vaillant JC, Karoui M. Lymph node metastases in splenic flexure colon cancer: Is subtotal colectomy warranted? J Surg Oncol 2018; 118:1027-1033. [PMID: 30212600 DOI: 10.1002/jso.25169] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Tumors of the splenic flexure (TSF) can be associated with metastatic lymph nodes (LN) along the left colic pedicle, but also along the superior mesenteric vessels. We aimed to detail the anatomical distribution of metastatic LNs in patients undergoing elective subtotal colectomy for TSF. METHOD Between 2000 and 2016, 65 patients were included. At pathological analysis, LNs were classified into two groups: locoregional LN (along the left colic artery) and distant LN (along the middle colic, right colic, and ileocolic arteries). RESULTS The median number of LNs examined was 20. Eighteen patients (27%) were pN+. Among them, six (33% of pN+ patients and 9% of the series) had at least one positive distant LN. All these patients had a positive distant LN along the right colic artery. These patients had a significantly advanced stage and more positive LNs than the others (stage III-IV: 100% vs 22%, P = 0.0009 and 6 [3-15] vs 0 [0-15], P < 0.0001, respectively). The presence of synchronous metastases was predictor of metastatic distant LNs (P = 0.042). CONCLUSION Elective subtotal colectomy for TSF allows to discover distant positive LNs in nearly 10% of patients. For those having TSF and synchronous metastatic disease enable to resection, subtotal colectomy should be recommended.
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Affiliation(s)
- Gilles Manceau
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Arnaud Mori
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Armelle Bardier
- Department of Pathology, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Jeremy Augustin
- Department of Pathology, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Sylvie Breton
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Jean-Christophe Vaillant
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Mehdi Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
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25
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Abstract
Tumor stage, as determined by the Tumor, Node, Metastasis (TNM) staging system, is the single most influential factor determining treatment decisions and outcome among patients with colorectal cancer. Several stage-related elements in pathology reports consistently pose diagnostic challenges: recognition of serosal penetration by tumor (ie, pT3 vs pT4a), evaluation of regional lymph nodes, distinction between tumor deposits and effaced lymph nodes, and assessment of tumor stage in the neoadjuvant setting. This article discusses each of these issues in detail and provides practical tips regarding colorectal cancer staging.
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Affiliation(s)
- Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA.
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26
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Yang L, Xiong Z, Xie Q, He W, Liu S, Kong P, Jiang C, Guo G, Xia L. Prognostic value of total number of lymph nodes retrieved differs between left-sided colon cancer and right-sided colon cancer in stage III patients with colon cancer. BMC Cancer 2018; 18:558. [PMID: 29751794 PMCID: PMC5948673 DOI: 10.1186/s12885-018-4431-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/24/2018] [Indexed: 12/26/2022] Open
Abstract
Background The consensus is that a minimum of 12 lymph nodes should be analyzed at colectomy for colon cancer. However, right colon cancer and left colon cancer have different characteristics, and this threshold value for total number of lymph nodes retrieved may not be universally applicable. Methods The data of 63,243 patients with colon cancer treated between 2004 and 2012 were retrieved from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Multivariate Cox regression analysis was used to determine the predictive value of total number of lymph nodes for survival after adjusting for lymph nodes ratio. The predictive value in left-sided colon cancer and right-sided colon cancer was compared. The optimal total number of lymph nodes cutoff value for prediction of overall survival was identified using the online tool Cutoff Finder. Survival of patients with high total number of lymph nodes (≥12) and low total number of lymph nodes (< 12) was compared by Kaplan–Meier analysis. Results After stratifying by lymph nodes ratio status, total number of lymph nodes≥12 remained an independent predictor of survival in the whole cohort and in right-sided colon cancer, but not in left-sided colon cancer. The optimal cutoff value for total number of lymph nodes was determined to be 11. Low total number of lymph nodes (< 11) was associated with significantly poorer survival after adjusting for lymph nodes ratio in all subgroups except in the subgroup with high lymph nodes ratio (0.5–1.0). Conclusions Previous reports of the prognostic significance of total number of lymph nodes on node-positive colon cancer were confounded by lymph nodes ratio. The 12-node standard for total number of lymph nodes may not be equally applicable in right-sided colon cancer and left-sided colon cancer. Electronic supplementary material The online version of this article (10.1186/s12885-018-4431-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lin Yang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhenchong Xiong
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qiankun Xie
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenzhuo He
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shousheng Liu
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Pengfei Kong
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chang Jiang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guifang Guo
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China. .,State Key Laboratory of Oncology in Southern China, Guangzhou, China. .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Liangping Xia
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road east, Guangzhou, 510060, China. .,State Key Laboratory of Oncology in Southern China, Guangzhou, China. .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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27
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Roseano M, Scaramucci M, Ciutto T, Balani A, Turoldo A, Zanconati F, Liguori G, Leggeri A. Sentinel Lymph Node Mapping in the Management of Colorectal Cancer: Preliminary Report. TUMORI JOURNAL 2018; 89:412-6. [PMID: 14606646 DOI: 10.1177/030089160308900413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim and background The problem of understaging the lymph node status in colorectal cancer because of missed micrometastases led authors to investigate the role of sentinel node (SN) mapping also in colorectal malignancies. The aim of this study was to evaluate the feasibility of the technique and to correlate the results with some characteristics of the primary tumor. Methods Sentinel lymph node mapping was performed in 23 patients who underwent a standard lymphadenectomy for colorectal cancer. The vital dye Patent Blue had been injected into the peritumoral subserosa in vivo in 17 cases and ex vivo in seven, including one case where the in vivo method did not allow to identify the sentinel node. The nodes that took up the dye were removed and analyzed with standard hematoxylin-eosin staining in serial sections. Immunohistochemistry (AE1-AE3 cytokeratin markers) was performed in hematoxylin-eosin-negative nodes. SN status was related to the status of the other lymph nodes in the surgical specimen analyzed with the standard technique and to the following characteristics of the primary tumor: stage, grade and diameter. Results The in vivo technique allowed to identify the SN in 16/17 cases (94.1%), the ex vivo technique in 7/7. A total of 336 lymph nodes dissected from the surgical specimens was analyzed, with an average of 14.6 nodes per patient (range, 7-35). Of these nodes 58 were SNs, with an average of 2.5 nodes per patient (range, 1-8). In the 19 cases where the SN was tumor negative, the non-SNs were also negative (specificity: 100%), whereas in the four cases where the non-SNs were positive, in two cases the SN was positive and in two cases of pT3 rectal carcinoma the SN was negative (sensitivity: 50%). Immunohistochemistry did not modify the negative results of the standard hematoxylin-eosin evaluation. Conclusions The method used to identify the SN using vital dye proved to be easy to use both in vivo and ex vivo and allowed to identify the SN in all cases. The preliminary results indicate that there is a risk of false negative findings and therefore further studies are required to improve the sensitivity and the specificity of the technique and to evaluate the role of SN mapping in colorectal cancer management.
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Affiliation(s)
- Mauro Roseano
- Department of Surgery, University of Trieste, Italy.
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Role of "Second Look" Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma. Gastroenterol Res Pract 2018; 2018:1985031. [PMID: 29805441 PMCID: PMC5902050 DOI: 10.1155/2018/1985031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/15/2018] [Indexed: 01/01/2023] Open
Abstract
As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated.
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Long-term oncologic outcomes after laparoscopic vs. open colon cancer resection: a high-quality population-based analysis in a Southern German district. Surg Endosc 2018; 32:4138-4147. [PMID: 29602999 PMCID: PMC6132887 DOI: 10.1007/s00464-018-6158-4] [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] [Received: 12/17/2017] [Accepted: 03/21/2018] [Indexed: 12/14/2022]
Abstract
Background Over 20 years after the introduction of laparoscopic surgery for colon cancer, many surgeons still prefer the open approach. Whereas randomized controlled trials (RCTs) have proven the oncologic safety of laparoscopy, long-term data depicting daily clinical routine are scarce. Methods This population-based cohort study compares 5-year overall, relative, and recurrence-free survival rates after laparoscopic and open colon carcinoma surgery. Data derive from an independent German cancer registry encompassing all tumor patients within a political district of 1.1 million inhabitants. The final analysis included 2669 patients with major elective resection of primary non-metastatic colonic adenocarcinoma between January 1, 2004 and December 31, 2013. Survival rates were compared using Kaplan–Meier analyses, relative survival models, and multivariate Cox regression. Sensitivity analysis quantified selection bias. Results The proportion of laparoscopic procedures increased from 9.7 to 25.8% in 2011 and dropped again to 15.8% at the end of observation period. Laparoscopy patients were younger, had a lower tumor stage, and were more likely to receive postoperative chemotherapy. Overall, relative, and recurrence-free survival was significantly superior or equivalent in Kaplan–Meier analysis (5-year overall survival rate open vs. laparoscopic: 69.0 vs. 80.2%, p < 0.001). The superiority of laparoscopy mostly remained stable after adjusting for confounders, although significance was only reached in T1-3 patients without lymph node metastases (overall survival: hazard ratio (HR) 0.654; 95% confidence interval (CI) 0.446–0.958; p = 0.029). Conclusion Laparoscopy is a safe and promising alternative to the open approach in daily clinic practice. These favorable outcomes require future confirmation by high-quality studies outside the setting of RTCs.
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30
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Alterations of lymph nodes evaluation after colon cancer resection: patient and tumor heterogeneity should be taken into consideration. Oncotarget 2018; 7:62664-62675. [PMID: 27577077 PMCID: PMC5308756 DOI: 10.18632/oncotarget.11633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/15/2016] [Indexed: 02/07/2023] Open
Abstract
Despite the adequacy of nodal evaluation was gradually improved for colon cancer (CC), rare attention has been paid for the effect of patient and tumor heterogeneity on nodal evaluation. We identified 109902 CC patients in stage I-III from Surveillance, Epidemiology, and End-Results (SEER) database during 2004-2013. The lymph nodes evaluations were separately assessed in different patient- and tumor-related features, including gender, age, T stage, histology, tumor differentiation, tumor size and tumor location. The 5-year cancer specific survival (CSS) was calculated with Kaplan-Meier method, log-rank tests were used to compare the differences of CSS in patients with ≥12 and <12 lymph nodes examined. Here, we identified features including gender, age, T stage, tumor differentiation, tumor size and location were independently associated with the median number of lymph node, the rate of ≥12 lymph nodes and the rate of node positivity of CC patients. We then divided CC patients into 29 subgroups according to different patient- and tumor-related features. The median number of lymph node presented a large variance from 12 to 24, the rate of ≥12 lymph nodes increased from 53.2% to 91.2% under the combined effect of patient and tumor heterogeneity. Furthermore, the positive association between increased lymph nodes count and improved survival couldn't be observed in 8261 CC patients with the effect of this heterogeneity. In conclusion, the tumor and patient heterogeneity lead to large alterations of nodal evaluation; we should pay more attention to this effect in clinical practice.
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Li Q, Liang L, Jia H, Li X, Xu Y, Zhu J, Cai S. Negative to positive lymph node ratio is a superior predictor than traditional lymph node status in stage III colorectal cancer. Oncotarget 2018; 7:72290-72299. [PMID: 27474167 PMCID: PMC5342162 DOI: 10.18632/oncotarget.10806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/14/2016] [Indexed: 01/16/2023] Open
Abstract
Negative lymph node counts has recently attracted attention as a prognostic indicator in colorectal cancer (CRC). But little is known about prognostic significance of negative to positive lymph node ratio (NPR) in CRC. Our aim was to determine impact of NPR on oncological outcomes in patients with stage III CRC. This retrospective study included 2,256 patients with stage III CRC under curative resection at Fudan university Shanghai cancer center. Kaplan-Meier methods and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors. Accuracy of the NPR was assessed with the Harrell's concordance-index(C-index).X-tile program identified 2.38 or 0.55/2.38 as the optimal cutoff value for NPR to divide the cohort into high/low risk or high/middle/low risk subsets in terms of CRC cause specific survival (CCSS). In a multivariate analysis, NPR was significant independent prognostic factors for CCSS (P<0.05), notably, N classification was not an independently prognostic factor (P>0.05). Further analysis found NPR could give detailed prognostic classification for both N1 and N2 stage (P<0.05). Interestingly, patients in N2+ NPR >2.38 stage have similar survival outcome with N1+ NPR >2.38 stage (χ2=0.030, P=0.863), and better than those at N1+ NPR ≤2.38 and N2+ NPR ≤2.38 stage (P<0.001). The TNNPRM stage was more accurate for predicting CCSS (C-index = 0.659) than current TNM stage system(C-index = 0.628) (P<0.001). Collectively, NPR was an independent prognostic factor for stage III CRC patients, it could provide more accurate prognostic information than the current node stage system.
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Affiliation(s)
- Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Liang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huixun Jia
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Statistics, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ji Zhu
- Center for Biomedical Statistics, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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32
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Guan X, Chen W, Liu Z, Jiang Z, Hu H, Zhao Z, Wang S, Chen Y, Wang G, Wang X. Whether regional lymph nodes evaluation should be equally required for both right and left colon cancer. Oncotarget 2018; 7:59945-59956. [PMID: 27494866 PMCID: PMC5312360 DOI: 10.18632/oncotarget.11007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/19/2016] [Indexed: 12/26/2022] Open
Abstract
Despite the adequacy of nodal evaluation was gradually improved for colon cancer, the disparity in nodal examination for right colon cancer (RCC) and left colon cancer (LCC) still begs the question of whether 12 nodes is an appropriate threshold for both RCC and LCC. From Surveillance, Epidemiology, and End-Results (SEER) database, we identified 53897 RCC patients and 11822 LCC patients. Compared with LCC patients, RCC patients examined more lymph nodes (18.7 vs 16.3), and more likely to examine ≥12 nodes (P<0.001), whereas RCC patients showed lower rates of node positivity (P<0.001). To balance the nodal disparity between RCC and LCC, we revised the 12-node measure based on different tumor locations. With the X-tile, we determined 15 as the optimal node number for RCC and 11 for LCC. To validate the availability of this revised nodal evaluation, the 5-year cancer specific survival (CSS) was calculated according to the optimal node number in RCC and LCC patients, Cox's regression model were used to further assess the prognostic value of this revised nodal evaluation. The results showed that 5-year CSSs were significantly improved for RCC patients with ≥15 lymph nodes, and also for LCC patients with ≥11 lymph nodes (P<0.001). This revised nodal evaluation could also improve the rate of nodal positivity and long-term survival in both RCC and LCC patients compared with 12-node measure. Therefore, the lymph node examination should be discriminately evaluated for RCC and LCC, instead of using 12-node measure to colon cancer as a whole.
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Affiliation(s)
- Xu Guan
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Chen
- Follow up center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zheng Liu
- Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zheng Jiang
- Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hanqing Hu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhixun Zhao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Song Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yinggang Chen
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xishan Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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33
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Widmar M, Keskin M, Strombom P, Beltran P, Chow OS, Smith JJ, Nash GM, Shia J, Russell D, Garcia-Aguilar J. Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches. Colorectal Dis 2017; 19. [PMID: 28649796 PMCID: PMC5642033 DOI: 10.1111/codi.13786] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM Studies have demonstrated a relationship between lymph node (LN) yield and survival after colectomy for cancer. The impact of surgical technique on LN yield has not been well explored. METHOD This is a retrospective study of right colectomy (RC) for cancer at a single institution from 2012 to 2014. Exclusion criteria were previous colectomy and emergent and palliative operations. All data were collected by chart review. Primary outcomes were LN yield and the LN to length of surgical specimen (LN-LSS) ratio. Multivariable mixed models were created with surgeon and pathologist as random effects. Sensitivity analyses were performed to exclude Stage IV cancers and to analyse groups on an 'as-treated' basis. RESULTS We identified 181 open (O-RC), 163 laparoscopic (L-RC) and 119 robotic (R-RC) right colectomies. O-RC was more commonly performed in women with metastatic disease. The mean LN yield was 28, 29 and 34 in O-RC, L-RC and R-RC, respectively; the respective mean LN-LSS ratios were 0.83, 0.91 and 1.0. The R-RC approach produced a higher LN yield than the other approaches (P < 0.01), and a higher LN-LSS ratio than O-RC (P < 0.01). These findings were unchanged in sensitivity analyses. CONCLUSION Robotic right colectomy improves LN yield and the LN-LSS ratio, which may reflect better mesocolic excision. The effect of these findings on survival requires further investigation.
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Affiliation(s)
- Maria Widmar
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center,Department of Surgery, Icahn School of Medicine at Mount Sinai
| | - Metin Keskin
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center
| | - Paul Strombom
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center
| | - Pedro Beltran
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center
| | - Oliver S Chow
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center
| | - J. Joshua Smith
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center
| | - Garrett M Nash
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Julio Garcia-Aguilar
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center
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Ahmad A, Reha J, Saied A, Espat NJ, Somasundar P, Katz SC. Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer. Hepatobiliary Surg Nutr 2017; 6:154-161. [PMID: 28652998 DOI: 10.21037/hbsn.2016.08.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The primary objective of our study was to assess the association of primary tumor lymph node ratio (LNR) in stage IV colorectal adenocarcinomas (CRC) with overall survival (OS) and the extent of metastatic disease in the liver. METHODS We analyzed data on 53 stage IV CRC patients who underwent surgical resection of the primary tumor. The median LNR of 0.25 was used to stratify patients into high LNR (H-LNR) and low LNR (L-LNR) groups. Statistical comparison was performed using chi square test and multiple regression models. OS was calculated using the Kaplan-Meier (KM) method while cox regression was used for multivariate analysis. RESULTS H-LNR status was associated with the presence of >3 liver metastases (LM) [odds ratio (OR): 2.43, P=0.047] and bilobar LM (OR: 3.94, P=0.039). The OS in H-LNR patients was significantly worse in the entire cohort compared to L-LNR (9% vs. 34% at 3 years, P=0.027). The 5-year OS in patients undergoing liver resection for LM was also significantly worse in the H-LNR group (0% vs. 37%, P=0.013). LNR was independently associated with survival on multivariate analysis [HR: 2.63; 95% confidence intervals (CI), 1.13-6.14; P=0.025]. CONCLUSIONS In stage IV CRC, LNR is associated with the extent of hepatic tumor burden and was an independent predictor of survival in patients undergoing liver resection.
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Affiliation(s)
- Ali Ahmad
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA
| | - Jeffrey Reha
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA
| | - Abdul Saied
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - N Joseph Espat
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Ponnandai Somasundar
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Steven C Katz
- Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.,Department of Surgery, Boston University School of Medicine, Boston, MA, USA
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Almeida ALNRD, Bernardes MVAA, Feitosa MR, Peria FM, Tirapelli DPDC, Rocha JJRD, Feres O. Serological under expression of microRNA-21, microRNA-34a and microRNA-126 in colorectal cancer. Acta Cir Bras 2017; 31 Suppl 1:13-8. [PMID: 27142899 DOI: 10.1590/s0102-86502016001300004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This paper describes the ability of miRNA value predict oncological outcomes in CRC patients and correlates to clinical and pathologic variables. METHODS We prospectively analyzed the serological expression of microRNA-21, microRNA-34a, and microRNA-126 in 37 stage II - IV CRC patients and correlate to seven fit counterparts. Serological microRNAs were extracted using the miRNeasy Mini Kit(r) (Qiagen, Hilden, Germany). Quantification of microRNAs was performed using TaqMan Master Mix(r) reagent (Applied Biosystems, USA). RESULTS We obtained serological underexpression microRNA-21, microRNA-34a, and microRNA-126 in CRC group. However, miRNAs serological values do not impact prognosis. Furthermore, miRNAs was not influenced by CEA values, TNM staging, and histological subtype. CONCLUSION Despite lower expression of miR-21, miR-34a and miR-126 in the CRC group, no association with poor prognosis was found.
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Affiliation(s)
| | | | - Marley Ribeiro Feitosa
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | | | | | | | - Omar Feres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Diamantopoulos MA, Kontos CK, Kerimis D, Papadopoulos IN, Scorilas A. Upregulated miR-16 expression is an independent indicator of relapse and poor overall survival of colorectal adenocarcinoma patients. Clin Chem Lab Med 2017; 55:737-747. [PMID: 27930363 DOI: 10.1515/cclm-2016-0756] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/31/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Colorectal adenocarcinoma is one of the most common malignant tumors of the gastrointestinal tract and the second leading cause of cancer-related deaths among adults in Western countries. miR-16 is heavily involved in cancer progression. In this study, we examined the potential diagnostic and prognostic utility of miR-16 expression in colorectal adenocarcinoma. METHODS Total RNA was extracted from 182 colorectal adenocarcinoma specimens and 86 non-cancerous colorectal mucosae. After polyadenylation of 2 μg total RNA by poly(A) polymerase and subsequent reverse transcription with an oligo-dT adapter primer, miR-16 expression was determined using an in-house developed reverse transcription quantitative real-time PCR method, based on SYBR Green chemistry. SNORD43 (RNU43) and SNORD48 (RNU48) were used as reference genes. Next, we performed extensive biostatistical analysis. RESULTS miR-16 was shown to be significantly upregulated in colorectal adenocarcinoma specimens compared to non-cancerous colorectal mucosae, suggesting its potential exploitation for diagnostic purposes. Moreover, high miR-16 expression predicts poor disease-free survival (DFS) and overall survival (OS) of colorectal adenocarcinoma patients. Multivariate Cox regression analysis confirmed that miR-16 overexpression is a significant unfavorable prognosticator in colorectal adenocarcinoma, independent of other established prognostic factors, radiotherapy, and chemotherapy. Interestingly, miR-16 overexpression retains its unfavorable prognostic value in patients with advanced yet locally restricted colorectal adenocarcinoma that has not grown through the wall of the colon or rectum (T3) and in those without distant metastasis (M0). CONCLUSIONS Overexpression of the cancer-associated miR-16 predicts poor DFS and OS of colorectal adenocarcinoma patients, independently of clinicopathological factors that are currently used for prognostic purposes.
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Affiliation(s)
- Marios A Diamantopoulos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens
| | - Christos K Kontos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens
| | - Dimitrios Kerimis
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens
| | - Iordanis N Papadopoulos
- Fourth Surgery Department, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Panepistimiopolis, 15701 Athens
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Lymphadenectomy in Colorectal Cancer: Therapeutic Role and How Many Nodes Are Needed for Appropriate Staging? CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0349-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Robotic right hemicolectomy: Analysis of 108 consecutive procedures and multidimensional assessment of the learning curve. Surg Oncol 2016; 26:28-36. [PMID: 28317582 DOI: 10.1016/j.suronc.2016.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/18/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE Surgeons tend to view the robotic right colectomy (RRC) as an ideal beginning procedure to gain proficiency in robotic general and colorectal surgery. Nevertheless, oncological RRC, especially if performed with intracorporeal ileocolic anastomosis confectioning, cannot be considered a technically easier procedure. The aim of this study was to assess the learning curve of the RRC performed for oncological purposes and to evaluate its safety and efficacy investigating the perioperative and pathology outcomes in the different learning phases. METHODS Data on a consecutive series of 108 patients undergoing RRC with intracorporeal anastomosis between June 2011 and September 2015 at our institution were prospectively collected to evaluate surgical and short-term oncological outcomes. CUSUM (Cumulative Sum) and Risk-Adjusted (RA) CUSUM analysis were performed in order to perform a multidimensional assessment of the learning curve for the RRC surgical procedure. Intraoperative, postoperative and pathological outcomes were compared among the learning curve phases. RESULTS Based on the CUSUM and RA-CUSUM analyses, the learning curve for RRC could be divided into 3 different phases: phase 1, the initial learning period (1st-44th case); phase 2, the consolidation period (45th-90th case); and phase 3, the mastery period (91th-108th case). Operation time, conversion to open surgery rate and the number of harvested lymph nodes significantly improve through the three learning phases. CONCLUSIONS The learning curve for oncological RRC with intracorporeal anastomosis is composed of 3 phases. Our data indicate that the performance of RRC is safe from an oncological point of view in all of the three phases of the learning curve. However, the technical skills necessary to significantly reduce operative time, conversion to open surgery rate and to significantly improve the number of harvested lymph nodes were achieved after 44 procedures. These data suggest that it might be prudent to start the RRC learning curve by treating only benign diseases and to reserve the performance of oncological resection to when at least the initial learning phase has been completed.
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Kerimis D, Kontos CK, Christodoulou S, Papadopoulos IN, Scorilas A. Elevated expression of miR-24-3p is a potentially adverse prognostic factor in colorectal adenocarcinoma. Clin Biochem 2016; 50:285-292. [PMID: 27939727 DOI: 10.1016/j.clinbiochem.2016.11.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/25/2016] [Accepted: 11/29/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Several miRNAs are aberrantly expressed in cancer. miR-24-3p is involved in cancer-related cellular processes, including cell cycle control, cell growth, proliferation, and apoptosis. In this study, we examined the potential diagnostic and prognostic significance of miR-24-3p expression in colorectal adenocarcinoma. DESIGN AND METHODS Total RNA was isolated from 182 colorectal adenocarcinoma specimens and 86 paired non-cancerous colorectal mucosae. After polyadenylation of 2μg total RNA and reverse transcription into first-strand cDNA using an oligo-dT-adapter primer, miR-24-3p expression was quantified using an in-house-developed reverse-transcription real-time quantitative PCR method, based on the SYBR Green chemistry. SNORD43 (RNU43) was used as a reference gene. RESULTS miR-24-3p levels do not significantly differ between colorectal adenocarcinoma and non-cancerous colorectal mucosae. Thus, miR-24-3p expression cannot be used for diagnostic purposes. However, high miR-24-3p expression predicts poor disease-free survival (DFS) and overall survival (OS) of colorectal adenocarcinoma patients. Multivariate Cox regression analysis confirmed that miR-24-3p overexpression is a significant predictor of relapse in colorectal adenocarcinoma and that its prognostic significance is independent of other established prognostic factors and treatment of patients. Of note, miR-24-3p overexpression retains its rather unfavorable prognostic value in the subgroup of patients with advanced yet locally restricted colorectal adenocarcinoma (T3) and in those without distant metastasis (M0). Moreover, miR-24-3p overexpression is a potentially unfavorable prognosticator for patients who were not treated with radiotherapy. CONCLUSIONS Strong expression of miR-24-3p predicts poor DFS and OS of colorectal adenocarcinoma patients, independently of clinicopathological parameters that are currently used for prognosis in this human malignancy.
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Affiliation(s)
- Dimitrios Kerimis
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens GR-15701, Greece
| | - Christos K Kontos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens GR-15701, Greece
| | - Spyridon Christodoulou
- Fourth Surgery Department, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens GR-12462, Greece
| | - Iordanis N Papadopoulos
- Fourth Surgery Department, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens GR-12462, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens GR-15701, Greece.
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Lisovsky M, Schutz SN, Drage MG, Liu X, Suriawinata AA, Srivastava A. Number of Lymph Nodes in Primary Nodal Basin and a “Second Look” Protocol as Quality Indicators for Optimal Nodal Staging of Colon Cancer. Arch Pathol Lab Med 2016; 141:125-130. [DOI: 10.5858/arpa.2015-0401-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Evaluation of 12 or more lymph nodes (LNs) is currently used as a quality indicator for adequacy of pathologic examination of colon cancer resections.
Objective.—To evaluate the utility of a focused LN search in the immediate vicinity of the tumor and a “second look” protocol in improving LN staging in colon cancer.
Design.—Lymph nodes were submitted separately from the primary nodal basin (PNB) and secondary nodal basin (SNB) defined as an area less than 5 cm away and an area greater than 5 cm away from the tumor edge, respectively, in 201 consecutive resections (2010–2013). One hundred sixty-eight consecutive tumors (2006–2009) were used as a control group. A second search was performed in all cases that were N0 after the first search.
Results.—In cases that were N0 after the first search, 20.9 ± 10.8 LNs were collected from the PNB, compared to 8.5 ± 9.1 from the SNB. Positive LNs were found in N+ tumors in the PNB in all cases but in only 9% (4 of 46) of SNBs (P < .001). A second search increased node count by an average of 10 additional LNs. In 5 of 114 cases (4.4%), N0 after the first search converted to N+ after a second search that yielded 1 to 4 positive LNs, all of which were in the PNB.
Conclusions.—Emphasis on the number of LNs examined from the PNB and a “second look” protocol improve nodal staging.
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Affiliation(s)
| | | | | | | | | | - Amitabh Srivastava
- From the Department of Pathology (Drs Lisovsky, Liu, and Suriawinata and Ms Schutz), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and the Department of Pathology (Drs Drage and Srivastava), Brigham & Women's Hospital, Boston, Massachusetts
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Becerra AZ, Berho ME, Probst CP, Aquina CT, Tejani MA, Gonzalez MG, Xu Z, Swanger AA, Noyes K, Monson JR, Fleming FJ. Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base. Ann Surg Oncol 2016; 23:674-683. [DOI: 10.1245/s10434-016-5551-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Indexed: 01/27/2023]
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Huang B, Feng Y, Ni M, Chen C, Cai G. Heterogeneous survival between stage IIA and stage IIIA colon cancer when different numbers of lymph nodes are harvested. ANZ J Surg 2016; 88:316-321. [PMID: 27580642 DOI: 10.1111/ans.13737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/12/2016] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aim to compare the prognosis between patients with stage IIA and stage IIIA colon cancer. METHODS We analysed patients with stage IIA or stage IIIA colon cancer based on data from the US Surveillance, Epidemiology, and End Results (SEER) database. Survival data were generated as Kaplan-Meier curves and were compared by log-rank tests. A multivariate Cox proportional hazards model was used to analyze the risk factors. RESULTS In total, 43 379 patients (38 784 stage IIA and 4595 stage IIIA) were included from the SEER database. A Kaplan-Meier analysis showed no significant difference between patients with stage IIA and IIIA colon cancer (P = 0.547). In the subgroup of patients with number of lymph nodes harvested (LNH) ≥12, a multivariate analysis showed that compared with stage IIA patients, stage IIIA patients were more likely to have a poorer cancer-specific survival (CSS) (hazard ratio (HR) 1.252, 95% confidence interval (CI) 1.095-1.431, P = 0.001). In the subgroup of patients with LNH <12, a multivariate analysis showed that compared with stage IIA patients, stage IIIA patients were more likely to have a better CSS (HR 0.820, 95% CI 0.731-0.919, P = 0.001). CONCLUSIONS Patients with stage IIA colon cancer had a CSS comparable with that of patients with stage IIIA disease. When adequate lymph nodes were retrieved (LNH ≥12), stage IIA patients had a greater CSS than stage IIIA patients. On the contrary, when inadequate lymph nodes were retrieved (LNH <12), stage IIA patients had a poorer CSS than stage IIIA patients.
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Affiliation(s)
- Ben Huang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Feng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mengdong Ni
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chen Chen
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Kuo P, Mehra S, Sosa JA, Roman SA, Husain ZA, Burtness BA, Tate JP, Yarbrough WG, Judson BL. Proposing prognostic thresholds for lymph node yield in clinically lymph node-negative and lymph node-positive cancers of the oral cavity. Cancer 2016; 122:3624-3631. [DOI: 10.1002/cncr.30227] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/01/2016] [Accepted: 07/05/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Phoebe Kuo
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
| | - Saral Mehra
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
| | - Julie A. Sosa
- Department of Surgery; Endocrine Surgery, Duke University School of Medicine; Durham North Carolina
- Duke Clinical Research Institute; Durham North Carolina
- Duke Cancer Institute; Durham North Carolina
| | - Sanziana A. Roman
- Department of Surgery; Endocrine Surgery, Duke University School of Medicine; Durham North Carolina
| | - Zain A. Husain
- Yale Cancer Center; New Haven Connecticut
- Department of Therapeutic Radiology; Yale School of Medicine; New Haven Connecticut
| | - Barbara A. Burtness
- Yale Cancer Center; New Haven Connecticut
- Department of Medicine; Yale School of Medicine; New Haven Connecticut
| | - Janet P. Tate
- Department of Internal Medicine; Veterans Affairs Connecticut Healthcare System; West Haven Connecticut
| | - Wendell G. Yarbrough
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
- Department of Pathology; Yale School of Medicine; New Haven Connecticut
| | - Benjamin L. Judson
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
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Choi JP, Park IJ, Lee BC, Hong SM, Lee JL, Yoon YS, Kim CW, Lim SB, Lee JB, Yu CS, Kim JC. Variability in the lymph node retrieval after resection of colon cancer: Influence of operative period and process. Medicine (Baltimore) 2016; 95:e4199. [PMID: 27495024 PMCID: PMC4979778 DOI: 10.1097/md.0000000000004199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate variations in the number of retrieved lymph nodes (LNs) over time and to determine the factors that influence the retrieval of <12 LNs during colon cancer resection.Patients with colon cancer who were surgically treated between 1997 and 2013 were identified from our institutional tumor registry. Patient, tumor, and pathologic variables were evaluated. Factors that influenced the retrieval of <12 LNs were evaluated using multivariate logistic regression modeling, including time effects.In total, 6967 patients were identified. The median patient age was 61 years (interquartile range [IQR] = 45-79 years) and 58.4% of these patients were male. The median number of LNs retrieved was 21 (IQR = 14-29), which increased from 14 (IQR = 11-27) in 1997 to 26 (IQR = 19-34) in 2013. The proportion of patients with ≥12 retrieved LNs increased from 72% in 1997 to 98.8% in 2013 (P < 0.00001). This corresponded to the more recent emphasis on a multidisciplinary approach to adequate LN evaluation. The number of retrieved LNs was also found to be associated with age, sex, tumor location, T stage, and operative year. Tumor location and T stage influenced the number of retrieved LNs, irrespective of the operative year (P < 0.05). Factors including a tumor location in the sigmoid/left colon, old age, open resection, earlier operative year, and early T stage were more likely to be associated with <12 recovered LNs (P < 0.5; chi-squared test) (P < 0.001).The total number of retrieved LNs may be influenced by tumor location and T stage of a colon cancer, irrespective of the year of surgery. LN retrieval after colon cancer resection has increased in recent years due to a better awareness of its importance and the use of multidisciplinary approaches.
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Affiliation(s)
- Jung Pil Choi
- Department of Surgery, Dong Kang Medical Center, Ulsan
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
- Correspondence: In Ja Park, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea (e-mail: )
| | - Byung Cheol Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Seung Mo Hong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
| | - Jin Cheon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center
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Divi V, Harris J, Harari PM, Cooper JS, McHugh J, Bell D, Sturgis EM, Cmelak AJ, Suntharalingam M, Raben D, Kim H, Spencer SA, Laramore GE, Trotti A, Foote RL, Schultz C, Thorstad WL, Zhang QE, Le QT, Holsinger FC. Establishing quality indicators for neck dissection: Correlating the number of lymph nodes with oncologic outcomes (NRG Oncology RTOG 9501 and RTOG 0234). Cancer 2016; 122:3464-3471. [PMID: 27419843 DOI: 10.1002/cncr.30204] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Prospective quality metrics for neck dissection have not been established for patients with head and neck squamous cell carcinoma. The purpose of this study was to investigate the association between lymph node counts from neck dissection, local-regional recurrence, and overall survival. METHODS The number of lymph nodes counted from neck dissection in patients treated in 2 NRG Oncology trials (Radiation Therapy Oncology Group [RTOG] 9501 and RTOG 0234) was evaluated for its prognostic impact on overall survival with a multivariate Cox model adjusted for demographic, tumor, and lymph node data and stratified by the postoperative treatment group. RESULTS Five hundred seventy-two patients were analyzed at a median follow-up of 8 years. Ninety-eight percent of the patients were pathologically N+. The median numbers of lymph nodes recorded on the left and right sides were 24 and 25, respectively. The identification of fewer than 18 nodes was associated with worse overall survival in comparison with 18 or more nodes (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.09-1.74; P = .007). The difference appeared to be driven by local-regional failure (HR, 1.46; 95% CI, 1.02-2.08; P = .04) but not by distant metastases (HR, 1.08; 95% CI, 0.77-1.53; P = .65). When the analysis was limited to NRG Oncology RTOG 0234 patients, adding the p16 status to the model did not affect the HR for dissected nodes, and the effect of nodes did not differ with the p16 status. CONCLUSIONS The removal and identification of 18 or more lymph nodes was associated with improved overall survival and lower rates of local-regional failure, and this should be further evaluated as a measure of quality in neck dissections for mucosal squamous cell carcinoma. Cancer 2016;122:3464-71. © 2016 American Cancer Society.
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Affiliation(s)
- Vasu Divi
- Stanford University, Stanford, California
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | | | - Diana Bell
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Mohan Suntharalingam
- Marlene & Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - David Raben
- University of Colorado Denver, Aurora, Colorado
| | - Harold Kim
- Academic Radiation Oncology, Wayne State University, Detroit, Michigan
| | | | | | - Andy Trotti
- H. Lee Moffitt Cancer Center, Tampa, Florida
| | | | | | - Wade L Thorstad
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Qiang Ed Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Impact of age on the prognostic value of number of lymph nodes retrieved in patients with stage II colorectal cancer. Int J Colorectal Dis 2016; 31:1307-13. [PMID: 27234041 DOI: 10.1007/s00384-016-2602-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE A small number of lymph nodes retrieved (NLNR) is a known risk factor in stage II colorectal cancer. NLNR is influenced by age, but little is known about whether the impact of small NLNR on survival differs with age. This retrospective study sought to determine such impact in elderly patients with stage II colorectal cancer. METHODS We reviewed data for 2100 patients with stage II colorectal cancer who underwent surgery without adjuvant chemotherapy between January 1997 and December 2003. The optimal cutoff value of NLNR for survival was determined, and the impact of small NLNR on survival was analyzed. The association between age and NLNR was evaluated. The relation between age and risk of small NLNR with respect to survival was then assessed to determine the impact of small NLNR on elderly patients' survival. RESULTS The optimal cutoff value of NLNR was determined as 6. The small NLNR group (SNG) showed significantly worse prognosis than the large NLNR group (LNG) (p < 0.001). Age, surgical method, and scope of lymph node dissection were significantly associated with NLNR. A potential interaction was noted between age and risk of small NLNR in relation to relapse-free survival (RFS). Five-year RFS was significantly worse in SNG than in LNG for elderly patients (41.7 and 76.4 %, respectively; p < 0.001) but not for non-elderly patients (75.9 and 84.6 %, respectively; p = 0.083). CONCLUSIONS NLNR <6 was identified to be an important prognostic factor for elderly patients with stage II colorectal cancer.
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Wood P, Peirce C, Mulsow J. Non-surgical factors influencing lymph node yield in colon cancer. World J Gastrointest Oncol 2016; 8:466-473. [PMID: 27190586 PMCID: PMC4865714 DOI: 10.4251/wjgo.v8.i5.466] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/15/2015] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
There are numerous factors which can affect the lymph node (LN) yield in colon cancer specimens. The aim of this paper was to identify both modifiable and non-modifiable factors that have been demonstrated to affect colonic resection specimen LN yield and to summarise the pertinent literature on these topics. A literature review of PubMed was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens. The terms used for the search were: LN, lymphadenectomy, LN yield, LN harvest, LN number, colon cancer and colorectal cancer. Both non-modifiable and modifiable factors were identified. The review identified fifteen non-surgical factors: (13 non-modifiable, 2 modifiable) which may influence LN yield. LN yield is frequently reduced in older, obese patients and those with male sex and increased in patients with right sided, large, and poorly differentiated tumours. Patient ethnicity and lower socioeconomic class may negatively influence LN yield. Pre-operative tumour tattooing appears to increase LN yield. There are many factors that potentially influence the LN yield, although the strength of the association between the two varies greatly. Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.
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48
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Lymph node hypoplasia is associated with adverse outcomes in node-negative colon cancer using advanced lymph node dissection methods. Langenbecks Arch Surg 2016; 401:181-8. [PMID: 26879192 DOI: 10.1007/s00423-016-1377-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/01/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Lymph node size as a prognostic parameter has not been investigated well in the past. Recent data, however, have indicated that this parameter could be even more important than the lymph node count. METHODS Based on the results of earlier studies, we analyzed the lymph node size and number of node-negative colon cancer patients with regard to survival. Data from 115 node-negative cases of colon cancer were analyzed. Lymph nodes with diameters ≤5 mm were defined as small, and all other lymph nodes were classified as intermediate/large in size and labeled LN5. All of the cases were categorized according to the number of LN5s. The LN5 very low (LN5vl) group included cases with less than two LN5s. All of the other cases were assigned to the LN5 low/high (LN5l/h) group. RESULTS The overall survival analysis revealed significantly worse outcomes for the LN5vl group, with a mean survival of 34 months compared to the LN5l/h group, with a mean survival of 40 months (P = 0.022). After adjusting for the pT1/2 and pT3/4 stages, we still found a significant outcome difference (P = 0.012). Multivariate analysis identified LN5vl and T-stage as being independently correlated with the outcome. The vast majority of LN5vl cases (91 %) were located in the left colon. The location itself, however, was not prognostic (P = 0.478). CONCLUSION LN5 count, as a marker of immune response, could be shown as being prognostic in node-negative colon cancer. Patients with low LN5 counts showed poor outcomes. These patients could perhaps profit from adjuvant chemotherapy.
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Böttcher A, Dommerich S, Sander S, Olze H, Stromberger C, Coordes A, Jowett N, Knopke S. Nodal yield of neck dissections and influence on outcome in laryngectomized patients. Eur Arch Otorhinolaryngol 2016; 273:3321-9. [DOI: 10.1007/s00405-016-3928-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 02/05/2016] [Indexed: 12/15/2022]
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50
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Li Q, Liang L, Gan L, Cai G, Li X, Cai S. Effect of Lymph Node Count on Pathological Stage III Rectal Cancer with Preoperative Radiotherapy. Sci Rep 2015; 5:16990. [PMID: 26582242 PMCID: PMC4652213 DOI: 10.1038/srep16990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 10/22/2015] [Indexed: 12/31/2022] Open
Abstract
Lymph node (LN) status after surgery for rectal cancer is affected by preoperative radiotherapy. The purpose of this study was to perform a population-based evaluation of the impact of pathologic LN status after neoadjuvant radiotherapy on survival. A total of 1,650 patients receiving neoadjuvant chemotherapy in Surveillance, Epidemiology, and End Results Program (SEER)-registered ypIII stage rectal cancer was analyzed. We identified the optimal cutoff for retrieved LNs as 10 (χ2 = 14.006, P < 0.001), which was validated as an independent prognosis factors in a Cox regression model. Further analysis showed that the LN count was only a prognosis factor with the number from 8 to 16(except for 13).After the number 16, the 5-year survival rate decreased gradually. Collectively, our results confirmed that the number of LNs in yp III stage rectal patients was a prognosis factor only with the numbers from 8 to 16(except for 13). Using the total mesorectal excision technique with an adequate pathologic examination, a large number of LNs retrieved (≥17) might indicate worse tumor response grade and poorer survival.
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Affiliation(s)
- Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lei Liang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lu Gan
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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