Age and Lymph Node Positivity in Patients With Colon and Rectal Cancer in the US Military Health System

Predictors of nodal positivity in clinically under-staged patients with colon cancer: A National Cancer Database study and proposal of a predictive scoring system

BACKGROUND

Colon cancer pathological and clinical staging may be disoncordant. This study assessed patients with colon cancer in whom the nodal status was clinically understaged.

METHODS

Patients with stage I-III clinical node-negative colon cancer from the National Cancer Database were included. Regression analyses were conducted to elucidate risk factors for clinical nodal understaging and a scoring system was developed to identify high-risk patients.

RESULTS

The study included 94,945 patients with 78.4 ​% of patients correctly staged and 21.6 ​% clinically understaged. The predictors of nodal positivity in clinically understaged patients were age <65 (OR 1.43), left-sided tumors (OR 1.41), elevated CEA (OR 2.03), moderately (OR 1.81) or poorly/undifferentiated tumors (OR 3.76), T1 tumors (OR 1.29), signet-ring cell histology (OR 2.26), and microsatellite-stable tumors (OR 1.4).

CONCLUSION

Patients with colon cancer and the above factors are more likely to have their nodal status clinically understaged. A scoring system has been developed to identify high-risk patients.

Lymphatic spread patterns in young versus elderly patients with stage III colon cancer

BACKGROUND

The anatomical pattern of lymph nodes spread differs between young (aged 45 years or younger) and elderly (aged 80 years or older) patients with stage III colon cancer and is poorly investigated.

METHODS

Two groups of patients (young and elderly) with stage III colon cancer who underwent upfront extensive (D3) lymphadenectomy at eight Japanese centres between 1998 and 2018 were retrospectively analysed. The primary endpoint was the proportion of positive central lymph nodes. The lymph nodes spreading pattern and its prognostic impact on recurrence-free survival and overall survival in the two groups were also compared.

RESULTS

Two hundred and ten young patients and 348 elderly patients were identified and compared. The total number of lymph nodes harvested and the total number of invaded lymph nodes were significantly higher in younger patients compared with elderly patients (median of 31.5 (3-151) versus 21 (3-116), P < 0.001 and median of 3 (1-21) versus 2 (1-25), P < 0.001 respectively). The proportion of positive central lymph nodes were higher in younger patients than in elderly patients (9.52% (95% c.i. 6.24 to 14.2%) versus 4.59% (95% c.i. 2.84 to 7.31%), P = 0.012). In multivariate models for recurrence-free survival, central lymph nodes invasion were identified as a poor prognostic factor in younger patients (HR 5.21 (95% c.i. 1.76 to 15.39)) but not in elderly patients (HR 1.73 (95% c.i. 0.80 to 3.76)).

CONCLUSION

Young patients with stage III colon cancer have a higher risk of central lymph nodes invasion, suggesting a more aggressive disease biology. The presence of central lymph nodes invasion are associated with a worse outcome in young patients.

Comparing surgical and endoscopic resection approaches for colorectal neuroendocrine tumors within the diameter range of 10-20mm: an inverse probability weighting analysis based on the SEER database

Background

Currently, the primary treatment modalities for colorectal neuroendocrine tumors (CRNET) with a diameter between 10mm and 20mm are surgical resection (SR) and endoscopic resection (ER). However, it remains unclear which surgical approach yields the greatest survival benefit for patients.

Methods

This study included data from patients diagnosed with CRNET with tumor diameters ranging from 10mm to 20mm between the years 2004 and 2019, obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized into ER and SR groups based on the respective surgical approaches. Inverse probability weighting (IPTW) was employed to mitigate selection bias. Kaplan-Meier analysis and log-rank tests were utilized to estimate overall survival (OS) and cancer-specific survival (CSS). Cox regression analysis (univariate and multivariate) was performed to evaluate potential factors influencing survival.

Results

A total of 292 CRNET patients were included in this study (ER group: 108 individuals, SR group: 184 individuals). Prior to IPTW adjustment, Kaplan-Meier analysis and Cox proportional hazard regression analysis demonstrated that the OS and CSS of the SR group were inferior to those of the ER group. However, after IPTW adjustment, no statistically significant differences in prognosis were observed between the two groups. Subgroup analyses revealed that patients with muscular invasion, positive lymph nodes, or distant metastasis derived greater survival benefits from SR. Significant differences in OS and CSS between the two groups were also observed across different age groups.

Conclusion

For patients with mucosal-limited lesions and without local lymph node or distant metastasis, ER is the preferred surgical approach. However, for patients with muscular invasion or positive lymph nodes/distant metastasis, SR offers a better prognosis. The choice of surgical approach should be based on the specific clinical characteristics of patients within different subgroups.

MilCanEpi: Increased Capability for Cancer Care Research in the Department of Defense

The Military Health System (MHS) of the US Department of Defense (DoD) provides comprehensive medical care to over nine million beneficiaries, including active-duty members, reservists, activated National Guard, military retirees, and their family members. The MHS generates an extensive database containing administrative claims and medical encounter data, while the DoD also maintains a cancer registry that collects information about the occurrence of cancer among its beneficiaries who receive care at military treatment facilities. Collating data from the two sources diminishes the limitations of using registry or medical claims data alone for cancer research and extends their usage. To facilitate cancer research using the unique military health resources, a computer interface linking the two databases has been developed, called Military Cancer Epidemiology, or MilCanEpi. The intent of this article is to provide an overview of the MilCanEpi data system, describing its components, structure, potential uses, and limitations.

Risk factors of central area lymph nodes metastasis for guiding optimal right colon cancer surgery: A retrospective multicenter study.. [DOI: 10.21203/rs.3.rs-1991182/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: D3 or CME lymphadenectomy for right colon cancer (RCC) with lymph nodes metastasis (LNM) is strongly recommended but the anatomical landmark remains controversial. Central LNM predicted poor prognosis in RCC and determined the extent of lymphadenectomy. Methods: Data for 1712 RCC patients treated with D3/CME lymphadenectomy were reviewed. These patients had been treated in 9 centers. A total of 1023 RCC patients were enrolled in the derivation cohort while 689 patients were enrolled in the validation cohort. Results: The overall central LNM incidence was 12.58% (215/1712). In the derivation cohort, univariate and multivariate cox regression analyses revealed that preoperative N staging based on CT scan (OR=7.85, 95% CI, 4.53-14.51, p<0.001), tumor differentiation (OR=0.53, 95% CI, 0.33-0.86, p=0.01) and intraoperative view of tumor movability (OR=0.53, 95% CI, 0.33-0.86, p=0.02) were significant independent factors. Areas under receiver-operating characteristic curves (AUC) for assessing central LNM in the derivation and validation cohorts were 0.802 and 0.750, respectively. The risk-scoring system for patients with RCC was also established. A score of 0 points was the optimal cut-off value for central LNM. Compared to patients in the low-risk group, patients in the high-risk group exhibited worse overall survival outcomes (p<0.001).Conclusions: The established model can be used for preoperative assessment of the risk of central LNM in RCC patients, and for determining the landmark for D3/CME lymphadenectomy, therefore might contribute to decreased therapeutic complications and improved clinical outcomes.