Tumor-Stroma Lymph Node Involvement is a Heterogeneous Process and Adds to Prognosis for Stage III Colon Cancer Patients

Abstract Purpose Adjuvant chemotherapy for colon cancer with lymph node involvement (Stage III) has been the standard of care since the 1990s. Meanwhile, considerable evolvement of surgery combined with dedicated histopathological examinations may have led to stage migration. Furthermore, prognostic factors other than lymph node involvement have proven to affect overall survival. Thus, adjuvant chemotherapy in Stage III colon cancer should be reconsidered. The objective was to compare recurrence rates and survival in stage III colon cancer patients treated with or without adjuvant chemotherapy. Further, to assess the impact of extensive mesenterectomy, lymph node stage and vascular invasion on outcome. Methods Consecutive patients operated for Stage III colon carcinoma between 31 December 2005 and 31 December 2015 were identified in the pathological code register by matching colon (T67) and either adenocarcinoma (M81403) or mucinous adenocarcinoma (M84803), with lymph node (T08) and metastasis of adenocarcinoma (M81406 or M84806). Medical records of all identified patients were reviewed. Results Of 216 identified patients, 69 received no postoperative adjuvant chemotherapy (group NC), 69 insufficient adjuvant chemotherapy (FLV or < minimum recommended 6 cycles FLOX, group IC), and 78 sufficient adjuvant chemotherapy (≥ 6 cycles FLOX, group SC). When adjusted for age and comorbidity, 5-year overall survival did not differ statistically significant between groups (76% vs. 83% vs. 85%, respectively). Vascular invasion and a high lymph node ratio significantly reduced overall survival. Conclusion The findings imply that subgroups of Stage III colon cancer patients have good prognosis also without adjuvant chemotherapy. For definite conclusions about necessity of adjuvant chemotherapy, prospective trials are needed.

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Stroma-High Lymph Node Involvement Predicts Poor Survival More Accurately for Patients with Stage III Colon Cancer

Journal of Medical & Surgical Pathology ◽

10.4172/2472-4971.1000116 ◽

2016 ◽

Vol 01 (02) ◽

Cited By ~ 4

Author(s):

Gabi W van Pelt ◽

Torben F Hansen ◽

Esther Bastiaannet ◽

Sanne Kjær Frifeldt ◽

J Han JM van Krieken ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Lymph Node Involvement ◽

Stage Iii ◽

Poor Survival ◽

Stage Iii Colon Cancer ◽

Node Involvement ◽

High Lymph Node

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Evaluating the prognostic significance of lymphovascular invasion in stage II and III colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.685 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 685-685 ◽

Cited By ~ 1

Author(s):

Dorotea Mutabdzic ◽

Shalana BL O'Brien ◽

Elizabeth A. Handorf ◽

Karthik Devarajan ◽

Sanjay S. Reddy ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Lymph Node ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Lymphovascular Invasion ◽

Lymph Node Involvement ◽

Stage Ii ◽

Stage Iii ◽

Node Involvement

685 Background: Presence of lymphovascular invasion (LVI) is known to be a predictor of lymph node involvement in colon adenocarcinoma (CA). Lymph node involvement is associated with poorer prognosis necessitating adjuvant therapy. While some studies have suggested that LVI is a predictor of worse overall survival in early stage colon cancer, the significance of LVI on prognosis has not been tested in a comprehensive North American data set. Methods: Patients with stage II and III CA with LVI data available and those who received predefined standard of care treatment were identified from the National Cancer Data Base (NCDB) from 2011 to 2015. The relationship between LVI and overall survival was tested using Kaplan-Meier survival curves and Cox proportional hazards regression analysis after adjusting for relevant clinical and demographic variables. Hazard ratios and 95% confidence intervals are reported along with median overall survival (OS) where available. Results: The dataset included 93,070 patients with stage II and 66,701 patients with stage III CA. The proportion of patients with LVI was 13% in stage II and 47% in stage III CA. After adjusting for age, sex, gender, race, comorbidities, socioeconomic status, T, and N stage, LVI was associated with worse OS in stage II, HR 1.2 (1.15-1.25, p < 0.001), and in stage III, HR 1.25 (1.21-1.30, p < 0.001), CA. Median OS was 6.51 years with LVI versus. 6.85 years without LVI in stage II compared with 6.57 years with LVI versus not reached without LVI in stage III CA. Of the stage II patients with LVI, 20% received adjuvant chemotherapy (CT) and median OS was 6.91 years for those who did versus 6.07 years for those who did not receive CT. Conclusions: Our data suggest that LVI is an important predictor of OS in stage II and III CA. There is evidence that adjuvant chemotherapy improves OS in advanced CA but there remains uncertainty as to the benefit in stage II. Despite this uncertainty, guidelines suggest consideration of adjuvant CT in patients with high-risk stage II disease. Our data support the recommendation that LVI be considered a high-risk feature in stage II disease. Further studies are necessary to examine whether the type or duration of CT should differ for patients with CA and LVI.

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Lymph node involvement in colon cancer patients decreases with age; a population based analysis

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.06.002 ◽

2014 ◽

Vol 40 (11) ◽

pp. 1474-1480 ◽

Cited By ~ 7

Author(s):

H. Khan ◽

Adam J. Olszewski ◽

P. Somasundar

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Lymph Node Involvement ◽

Population Based ◽

Node Involvement

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The clinical significance of preoperative plasma fibrinogen levels and platelet counts in resectable colon cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02180-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Berrin Papila Kundaktepe ◽

Cigdem Papila

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cancer Patients ◽

Fibrinogen Level ◽

Venous Invasion ◽

Positive Association ◽

Lymph Node Involvement ◽

Plasma Fibrinogen ◽

Node Involvement

Abstract Background and aim Several aspects of the correlation between colon cancer and hemostatic markers are still unknown to many researchers in the field. In this study, we evaluated the association, if any, of preoperative platelet (PLT) counts and plasma fibrinogen levels with postoperative lymph node involvement and venous invasion in colon cancer patients. Methods This study retrospectively included eighty patients with colon cancer (mean age 58.09 years; 37% female 63% male). Results Patients with negative lymph nodes and venous invasion showed a significantly lower PLT count and higher fibrinogen level than their counterparts, i.e., patients with positive lymph nodes (p<0.001, all of them) and venous invasion (p<0.001, all of them). The results also showed a positive association of PLT counts and fibrinogen levels with lymphatic invasion (r=0.670, p<0.001 and r=0.639, p<0.001, respectively) and a positive association of PLT counts and fibrinogen levels with venous invasion (r=0.3988, p<0.001 and r=0.5268, p<0.001, respectively). According to the results of the ROC curve analysis, when the PLT count cutoff was 290/mm3, the sensitivity and specificity were 82% and 86.67%, respectively (AUC = 0.8840, p<0.0001, 95% CI 0.8084–0.9596). When the fibrinogen level cutoff was 310.0 mg/dL, the sensitivity and specificity were 72% and 96.67%, respectively (AUC 0.8790, p <0.0001, 95% CI 0.8067–0.9513). Conclusion The preoperative PLT count and plasma fibrinogen level may be considered key markers to monitor postoperative lymph node involvement and venous invasion in colon cancer patients.

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