Year 2020 / Volume 112 / Number 8
Original
Prognostic significance of lymph node count in high-risk node-negative colon carcinoma

609-614

DOI: 10.17235/reed.2020.6709/2019

Patricia Martínez Ortega, Javier A. Cienfuegos, Jorge Baixauli, Carlos Sánchez Justicia, Marta Abengózar, Carlos Pastor Idoate, José Luis Hernández Lizoáin,

Abstract
Background: the prognostic value of the number of lymph nodes isolated (< 12 versus ≥ 12) in the surgical specimen continues to be controversial. In this study, the impact of isolating fewer or more than 12 lymph nodes in stage II colon cancer with a high-risk biologic phenotype was analyzed, such as the presence of perineural invasion. Methods: all cases of stage II disease (T3-4N0M0) with perineural invasion (PNI+) were retrospectively identified from a prospective database of patients undergoing surgery for colon cancer. The cohort was divided into two groups depending on the number of lymph nodes isolated (< 12 vs ≥ 12). Apart from clinical and surgical data, the patterns of recurrence, overall (OS) and disease-free survival (DFS) at five and ten years were analyzed. Results: sixty patients met the inclusion criteria, 31.7 % had < 12 lymph nodes isolated and 68.3 % had more than 12 isolated. There were no clinical or surgical differences between the two groups. OS at five and ten years was significantly lower in the patients with < 12 lymph nodes isolated (84.2 %, 62.7 % vs 94.6 % and 91.6 %, p = 0.01). DFS at five and ten years was 51 % vs 86.5 %, respectively (p = 0.005). Conclusion: the number of lymph nodes isolated (with a cutoff of 12) in stage II colon cancer with PNI+ has prognostic value and should therefore be borne in mind when planning adjuvant chemotherapy.
Share Button
New comment
Comments
No comments for this article
References
1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA. Cancer J. Clin. 2019;69:7–34.
2. Amri R, Bordeianou LG, Berger DL. Effect of High-Grade Disease on Outcomes of Surgically Treated Colon Cancer. Ann. Surg. Oncol. 2016;23:1157–63.
3. Kang GH. Four molecular subtypes of colorectal cancer and their precursor lesions. Arch. Pathol. Lab. Med. 2011;135:698–703.
4. A Cienfuegos J, Baixauli J, Arredondo J, et al. Clinico-pathological and oncological differences between right and left-sided colon cancer (stages I-III): analysis of 950 cases. Rev. Esp. Enferm. Dig. 2018;110:138–144.
5. Gill S, Loprinzi CL, Sargent DJ, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J. Clin. Oncol. 2004;22:1797–1806.
6. Benson 3rd AB, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J. Clin. Oncol. 2004;22:3408–3419.
7. Liska D, Stocchi L, Karagkounis G, et al. Incidence, patterns, and predictors of locoregional recurrence in colon cancer. Ann. Surg. Oncol. 2017;24:1093–1099.
8. Lavery IC, De Campos-Lobato LF. How to evaluate risk and identify stage II patients requiring referral to a medical oncologist: a surgeon’s perspective. Oncology (Williston Park). 2010;24:14–6..
9. Shia J, Wang H, Nash GM, et al. Lymph node staging in colorectal cancer: revisiting the benchmark of at least 12 lymph nodes in R0 resection. J. Am. Coll. Surg. 2012;214:348–355.
10. Chang GJ, Rodriguez-Bigas MA, Skibber JM, et al. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J. Natl. Cancer Inst. 2007;99:433–441.
11. Skancke M, Arnott SM, Amdur RL, et al. Lymphovascular invasion and perineural invasion negatively impact overall survival for stage II adenocarcinoma of the colon. Dis. Colon Rectum 2019;62:181–188.
12. Alotaibi AM, Lee JL, Kim J, et al. Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer. Ann. Surg. Oncol. 2017;24:1626–1634.
13. Compton CC, Byrd DR, Garcia-Aguilar J, et al. AJCC Cancer Staging Atlas. 2 2013. New York, NY: Springer New York; 2012.
14. Chang GJ, Kaiser AM, Mills S,et al. Practice parameters for the management of colon cancer. Dis. Colon Rectum 2012;55:831–843.
15. Washington MK, Berlin J, Branton P, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch. Pathol. Lab. Med. 2009;133:1539–1551.
16. Hamilton SR, Bosman FT, Boffetta P, et al. Carcinoma of the colon and rectum. In: FT B, Carneiro F, Hruban R, ND T, editors. WHO classification of tumours of the digestive system.Vol 4th. Lyon: International Agency for Research on Cancer, 2010:134–146.
17. Batsakis JG. Nerves and neurotropic carcinomas. Ann. Otol. Rhinol. Laryngol. 1985;94:426–427.
18. Sato T, Ueno H, Mochizuki H, et al. Objective criteria for the grading of venous invasion in colorectal cancer. Am. J. Surg. Pathol. 2010;34:454–462.
19. Andre T, Sargent D, Tabernero J, et al. Current issues in adjuvant treatment of stage II colon cancer. Ann. Surg. Oncol. 2006;13:887–898.
20. Benson AB, Venook AP, Cederquist L, et al. Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Canc. Netw. 2017;15:370–398
21. Budde CN, Tsikitis VL, Deveney KE, et al. Increasing the number of lymph nodes examined after colectomy does not improve colon cancer staging. J. Am. Coll. Surg. 2014;218:1004–11..
22. Cienfuegos JA, Martínez P, Baixauli J, et al. Perineural invasion is a major prognostic and predictive factor of response to adjuvant chemotherapy in stage I-II colon cancer. Ann. Surg. Oncol. 2016;24:1077–1084..
23. Swanson RS, Compton CC, Stewart AK, et al. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann. Surg. Oncol. 2003;10:65–71.
24. Namm J, Ng M, Roy-Chowdhury S, et al. Quantitating the impact of stage migration on staging accuracy in colorectal cancer. J. Am. Coll. Surg. 2008;207:882–7..
25. Jass JR, Love SB, Northover JM. A new prognostic classification of rectal cancer. Lancet (London, England) 1987;1:1303–1306.
26. Märkl B, Wieberneit J, Kretsinger H, et al. Number of Intratumoral T Lymphocytes Is Associated With Lymph Node Size, Lymph Node Harvest, and Outcome in Node-Negative Colon Cancer. Am. J. Clin. Pathol. 2016;145:826–36
27. Galon J, Costes A, Sanchez-Cabo F, et al. Type, density, and location of immune cells within human colorectal tumors predict clinical outcome. Science 2006;313:1960–4.
28. Fridman WH, Pages F, Sautes-Fridman C,et al. The immune contexture in human tumours: impact on clinical outcome. Nat. Rev. 2012;12:298–306.
29. Pagès F, Mlecnik B, Marliot F, et al. International validation of the consensus Immunoscore for the classification of colon cancer: a prognostic and accuracy study. Lancet 2018;391:2128–2139.
30. Moore J, Hyman N, Callas P, et al. Staging error does not explain the relationship between the number of lymph nodes in a colon cancer specimen and survival. Surgery 2010;147:358–65..
31. Pereira ER, Kedrin D, Seano G, et al. Lymph node metastases can invade local blood vessels, exit the node, and colonize distant organs in mice. Science 2018;359:1403–1407.
32. Brown M, Assen FP, Leithner A, et al. Lymph node blood vessels provide exit routes for metastatic tumor cell dissemination in mice. Science 2018;359:1408–1411..
33. Evans MD, Barton K, Rees A, et al.. The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease. Colorectal Dis. 2008;10:157–64.
Related articles

Letter

Retroperitoneal enterogenous cyst combined with teratoma

DOI: 10.17235/reed.2023.9799/2023

Letter

Surgical indication of type I gastric neuroendocrine tumors

DOI: 10.17235/reed.2023.9681/2023

Letter

Intestinal obstruction due to pneumatosis intestinalis

DOI: 10.17235/reed.2023.9608/2023

Letter

Duodenal stenosis surgical treatment in Crohn’s disease

DOI: 10.17235/reed.2023.9521/2023

Digestive Diseases Image

An unusual cause of a protuberant lesion of the gastric antrum

DOI: 10.17235/reed.2022.8771/2022

Letter

Cytomegalovirus colitis seems to be colon cancer. HIV debut

DOI: 10.17235/reed.2022.8699/2022

Letter

Sigmoid colon Schwannoma simulating colon cancer

DOI: 10.17235/reed.2022.8684/2022

Digestive Diseases Image

Gastric gastrointestinal stromal tumor abscess

DOI: 10.17235/reed.2022.8580/2022

Review

A review of the diagnosis and management of liver hydatid cyst

DOI: 10.17235/reed.2021.7896/2021

Letter

Radical surgery for liver hydatidosis

DOI: 10.17235/reed.2021.7743/2020

Digestive Diseases Image

Duodenal diverticulum causing obstructive jaundice – Lemmel’s syndrome

DOI: 10.17235/reed.2020.7516/2020

Letter

Bezoar in incarcerated and complicated hiatal hernia

DOI: 10.17235/reed.2019.6159/2019

Editorial

Safe surgery for cystic tumors of the pancreas

DOI: 10.17235/reed.2019.6042/2018

Editorial

Colorectal cancer screening and survival

DOI: 10.17235/reed.2018.5870/2018

Letter to the Editor

Consequences of a Dieulafoy’s lesion in gastric surgery

DOI: 10.17235/reed.2018.5442/2017

Letter to the Editor

Abdominal compartment syndrome secondary to acute necrotizing pancreatitis

DOI: 10.17235/reed.2017.4810/2016

Original

Usefulness of an intra-gastric balloon before bariatric surgery

DOI: 10.17235/reed.2017.4624/2016

Letter to the Editor

Transanal submucosal endoscopic resection (TASER) by TEO system®

DOI: 10.17235/reed.2016.4154/2015

Original

Self-expanding metal stents in postoperative esophageal leaks

DOI: 10.17235/reed.2016.3987/2015

Letter to the Editor

Minimally invasive treatment of rectovesical fistula: A case report

DOI: 10.17235/reed.2016.4017/2015

Case Report

Primary squamous cell carcinoma of the rectum: an atypical histology

DOI: 10.17235/reed.2016.3975/2015

Citation tools
Martínez Ortega P, Cienfuegos J, Baixauli J, Sánchez Justicia C, Abengózar M, Pastor Idoate C, et all. Prognostic significance of lymph node count in high-risk node-negative colon carcinoma. 6709/2019


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1198 visits.
This article has been downloaded 112 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 29/10/2019

Accepted: 31/01/2020

Online First: 04/06/2020

Published: 30/07/2020

Article revision time: 50 days

Article Online First time: 219 days

Article editing time: 275 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology