Prognostic Significance of Preoperative Serum Carcinoembryonic Antigen Varies with Lymph Node Metastasis Status in Colorectal Cancer

Background. Preoperative serum level of carcinoembryonic antigen (pCEA) is generally recognized as a prognostic factor for colorectal cancer (CRC), but the stage-specific role of pCEA in colorectal cancer remains unclear. Objective. We investigated the prognostic significance of pCEA levels in different tumor stages of nonmetastatic CRC patients. Methods. Six hundred and fifteen CRC patients at stage I–III were retrospectively analyzed. All of them received curative tumor resection. The X-tile program was used to generate stage-specific cutoff values of pCEA for all patients and two subpopulations (lymph node-positive or -negative). The prognostic significance of pCEA was assessed using Kaplan–Meier analysis and Cox proportional hazards regression analysis. A nomogram model that combined pCEA score and clinical feature indexes was established and evaluated. Results. Two cutoff values were identified in the study population. At a cutoff value of 4.9 ng/mL, a significantly higher 5-year overall survival (OS) rate (82.16%) was observed in the pCEA-low group (<4.9 ng/mL) compared with 65.52% in the pCEA-high group (≥4.9 ng/mL). Furthermore, at the second cutoff value of 27.2 ng/mL, 5-year OS was found to be only 40.9%. Stratification analysis revealed that preoperative serum level of pCEA was an independent prognostic factor (OR = 1.991, P < 0.01 ) in the subpopulation of lymph node metastasis (stage III) patients, and the relative survival rates in the pCEA-low (≤4.9 ng/mL), pCEA-medium (4.9–27.2 ng/mL), and pCEA-high (≥27.2 ng/mL) groups were 73.4%, 60.5%, and 24.8%, respectively ( P < 0.05 ). However, no such effect was observed in the lymph node nonmetastasis (stage I and II) subgroup. The established nomogram showed acceptable predictive power of the 5-year OS rate (C-index: 0.612) in lymph node-positive CRC patients, with an area under the curve value of 0.772, as assessed by ROC curve analysis. Conclusions. Pretreatment serum CEA levels had different prognostic significance based on the lymph node metastasis status. Among stage III CRC patients, pCEA was an independent prognostic factor. Five-year OS rates could be predicted according to the individual pCEA level at the different cutoff values.

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Horizontal spread of pericolic lymph node metastasis as a prognostic factor for recurrence in Stage III colorectal cancer

Colorectal Disease ◽

10.1111/codi.15586 ◽

2021 ◽

Author(s):

Taketo Sasaki ◽

Kohei Shigeta ◽

Koji Okabayashi ◽

Masashi Tsuruta ◽

Ryo Seishima ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Lymph Node Metastasis ◽

Stage Iii ◽

Node Metastasis ◽

Horizontal Spread

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Reappraisal of Serosal Invasion in Patients With T3 Colorectal Cancer by Elastic Stain: Clinicopathologic Study of 139 Surgical Cases With Special Reference to Peritoneal Elastic Lamina Invasion

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2014-0647-oa ◽

2016 ◽

Vol 140 (1) ◽

pp. 81-85 ◽

Cited By ~ 7

Author(s):

Yukihiro Nakanishi ◽

Charles LeVea ◽

Shiva Dibaj ◽

Fadi Habib ◽

Richard Cheney ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Prognostic Significance ◽

Serosal Invasion ◽

Node Metastasis ◽

Clinicopathologic Study ◽

Clinicopathologic Factors ◽

Elastic Stain ◽

Elastic Lamina

Context Peritoneal elastic lamina invasion (PELI) has been reported to be an important adverse prognostic factor in pT3 colorectal cancer (CRC). However, the data supporting this contention are limited. Objective To clarify the associations between PELI of pT3 CRC and prognostic significance, 139 consecutive surgical cases of pT3 CRC were examined. Design One hundred thirty-nine consecutive in-house surgical cases of pT3 CRC between 1993 and 2011 were examined. Thirty consecutive surgical cases of pT4a CRC resected during the same period were examined for comparison. Case selections were restricted to pT3 CRCs with the sections containing the deepest adenocarcinoma invasion partially or entirely covered with the peritoneum. Elastic staining was performed on one section containing the deepest tumor invasion partially or entirely covered with the peritoneum. The associations between the presence of PELI and clinicopathologic factors including prognosis of the patients were examined. Results Peritoneal elastic lamina invasion was identified in 23.0% (32 of 139) of the pT3 CRCs. PELI was associated with primary site (P = .006), lymph node metastasis (P < .001), lymphovascular invasion (P < .001), recurrence (P = .007), and patient's age (P = .002). The proportions of patients with a 4-year recurrence-free period in those with negative PELI, positive PELI, and pT4a tumor were 90.3%, 66.7%, and 28.9%, respectively (P < .001). Conclusions Elastic staining is useful to evaluate the serosal invasion of CRC. Positive PELI is a significant predictive factor for lymph node metastasis and recurrence-free survival in patients with pT3 CRC. This indicates that pT3 tumors with PELI should be treated like pT4a tumors.

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Analysis of risk factors and prognosis of 253 lymph node metastasis in colorectal cancer patients

BMC Surgery ◽

10.1186/s12893-021-01276-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shidong Hu ◽

Songyan Li ◽

Da Teng ◽

Yang Yan ◽

Haiguan Lin ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Cancer Patients ◽

Staining Intensity ◽

Node Negative ◽

Node Metastasis ◽

Lymph Node Positive ◽

Colorectal Cancer Patients

Abstract Background This study aimed to explore potential risk factors for 253 lymph node metastasis, and to identify the prognostic impact of 253 lymph node metastasis in colorectal cancer patients. Methods A retrospective study was conducted of 391 colorectal cancer patients who underwent surgical treatments that included 253 lymph node dissection. Clinicopathological features, molecular indexes and 1-year overall survival rates were analyzed. Results Univariate analyses revealed the following risk factors for 253 lymph node metastasis: high preoperative levels of CEA, large tumour max diameters, and numbers of harvested lymph nodes, presence of vessel carcinoma emboli, low level of MSH6 and MLH1 immunohistochemical staining intensity. Multivariate analysis showed that elevated MLH1 immunohistochemical staining intensity was an independent protective factor for 253 lymph node metastasis (OR: 0.969, 95% CI 0.945, 0.994, P = 0.015). A significant difference was found in 1-year overall survival rate between 253 lymph node-positive and lymph node-negative colorectal cancer patients (88.9% vs.75.0%, P < 0.001). Conclusions 253 lymph node-positive colorectal cancer patients had a worse prognosis than the 253 lymph node-negative patients. 253 lymph node dissection may improve the prognosis of colorectal cancer patients with high risk factors for 253 lymph node metastasis.

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IS A STUDY OF THE LEVEL OF CARBOHYDRATE ANTIGEN (CA 19-9) EFFECTIVE IN PATIENTS WITH COLORECTAL CANCER?

Problems in oncology ◽

10.37469/0507-3758-2020-66-5-528-534 ◽

2020 ◽

Vol 66 (5) ◽

pp. 528-534

Author(s):

Ye. Rybakov ◽

Mikhail Tarasov ◽

S. Chernyshov ◽

Marina Sukhina ◽

V. Charikov ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Distant Metastasis ◽

Perineural Invasion ◽

Serum Levels ◽

Lymphatic Invasion ◽

Node Metastasis ◽

Preoperative Serum ◽

Invasion Stage

Objective. Саrbohydrаte antigen 19-9 (CA 19-9) is the frequently used tumor marker in the clinical setting of colorectal cancer (CRC). This study was designed to investigate the correlation between preoperative serum levels of CA 19-9 (pre-CA 19-9) and the clinicopathologic factors of patients with CRC. Patients and methods. A study was performed on 482 patients with histologically diagnosed colorectal adenocarcinoma between January 2016 and December 2017, based on retrospective collected data. The clinical data such as age, sex, size of tumor, differentiation (G), depth of tumor (T), lymph node metastasis (N), distant metastasis (M), lymphatic invasion, venous invasion, perineural invasion, stage, and preoperative serum levels of CEA (pre-CEA) and pre-CA 19-9 were obtained. These patients were classified into two groups according to pre-CA 19-9 (CA 19-9 high: H37 U/mL; CA 19-9 normal: H37 U/mL). Results. Eighty five patients among 483 patients (17.6%) with CRC showed a high pre-CA 19-9. The elevationof pre-CA 19-9 was significantly associated with size of tumor > 4.5 cm (р=0.0001), higt CEA > 5ng/ml (р<0.0001), wrong differenciation of tumor (р=0.0003), depth of tumor (р<0.0001), lymph node metastasis (р<0.0001), distant metastasis (р<0.0001), lymphatic invasion (р=0.0013), vascular invasion (р<0.0001), perineural invasion (р<0.0001), stage (р<0.0001). On multivariate analysis, high pre-CA 19-9 was shown to be independently associated with depth of tumor (р=0.05), lymph node metastasis (р=0.0006). Spearman>s correlation coefficient r between REA and CA 19-9 was 0.21 (95% CI 0.13 - 0.30; p<0.0001). Conclusion. High pre-CA 19-9 in advanced colorectal cancer might provide important information to predict the depth of tumor, lymph node metastasis.

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Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) Database Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9103268 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3268

Author(s):

Seung Eun Lee ◽

Yoo Shin Choi ◽

Yong Hoon Kim ◽

Jin Seok Heo ◽

Chi-Young Jeong ◽

...

Keyword(s):

Lymph Node ◽

Prognostic Factor ◽

Lymph Node Metastasis ◽

Prognostic Significance ◽

Tumor Location ◽

Poor Prognostic Factor ◽

Tumor Registry ◽

Node Metastasis ◽

Registry System ◽

Extended Cholecystectomy

Background: T2 gallbladder cancer (GBC) is subdivided into T2a and T2b by the American Joint Committee on Cancer (AJCC) 8th edition. However; there is a lack of evidence for the prognostic significance of tumor location and validation with large-scale studies is needed. The aims of this study were to investigate the clinical features and clinical outcomes of T2 GBC according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy. Methods: Between 2000 and 2014 the Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) database was used to identify and enroll a total 707 patients with pathologically diagnosed T2 GBC who underwent curative resection. Clinicopathological findings and long-term follow-up results were analyzed. Results: The incidence of lymph node metastasis in T2b was significantly higher than that of T2a tumors (37.9% vs. 29.5%, p = 0.032). The 5-year disease-specific survival of T2a was better than that of T2b tumors (74.8% vs. 65.4%, p = 0.019). There was no significant survival difference in T2a between extended cholecystectomy and simple cholecystectomy with lymph node dissection (81.8% vs. 73.7%, p = 0.361). However; there was a better survival trend for T2b tumor after extended cholecystectomy (71.7% vs. 59.3%, p = 0.057). Adjuvant chemotherapy was associated with improved survival for patients with lymph node metastasis in T2a (72.1% vs. 56.9; p = 0.022) and in T2b (68.2 vs. 48.5; p < 0.001). Multivariate analysis revealed that lymph node metastasis was the only significant poor prognostic factor (Hazard ratio 3.222; 95% confidential interval 1.960–4.489; p < 0.001). Conclusions: For T2 GBC; tumor location was not an independent prognostic factor. Lymph node metastasis was a significant poor prognostic factor and adjuvant chemotherapy should be considered for the patients with lymph node metastasis.

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Microenvironmental markers are correlated with lymph node metastasis in invasive submucosal colorectal cancer

Histopathology ◽

10.1111/his.14388 ◽

2021 ◽

Author(s):

Tamotsu Sugai ◽

Noriyuki Yamada ◽

Mitsumasa Osakabe ◽

Mai Hashimoto ◽

Noriyuki Uesugi ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Node Metastasis ◽

Submucosal Colorectal Cancer

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Increased Expression of VANGL1 is Predictive of Lymph Node Metastasis in Colorectal Cancer: Results from a 20-Gene Expression Signature

Journal of Personalized Medicine ◽

10.3390/jpm11020126 ◽

2021 ◽

Vol 11 (2) ◽

pp. 126

Author(s):

Noshad Peyravian ◽

Stefania Nobili ◽

Zahra Pezeshkian ◽

Meysam Olfatifar ◽

Afshin Moradi ◽

...

Keyword(s):

Gene Expression ◽

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Candidate Genes ◽

Case Series ◽

Gene Expression Signature ◽

Gene Panel ◽

Expression Levels ◽

Node Metastasis

This study aimed at building a prognostic signature based on a candidate gene panel whose expression may be associated with lymph node metastasis (LNM), thus potentially able to predict colorectal cancer (CRC) progression and patient survival. The mRNA expression levels of 20 candidate genes were evaluated by RT-qPCR in cancer and normal mucosa formalin-fixed paraffin-embedded (FFPE) tissues of CRC patients. Receiver operating characteristic curves were used to evaluate the prognosis performance of our model by calculating the area under the curve (AUC) values corresponding to stage and metastasis. A total of 100 FFPE primary tumor tissues from stage I–IV CRC patients were collected and analyzed. Among the 20 candidate genes we studied, only the expression levels of VANGL1 significantly varied between patients with and without LNMs (p = 0.02). Additionally, the AUC value of the 20-gene panel was found to have the highest predictive performance (i.e., AUC = 79.84%) for LNMs compared with that of two subpanels including 5 and 10 genes. According to our results, VANGL1 gene expression levels are able to estimate LNMs in different stages of CRC. After a proper validation in a wider case series, the evaluation of VANGL1 gene expression and that of the 20-gene panel signature could help in the future in the prediction of CRC progression.

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16. Apical lymph node metastasis and survival in resected colorectal cancer

Pathology ◽

10.1097/01.pat.0000461625.51675.14 ◽

2015 ◽

Vol 47 ◽

pp. S105

Author(s):

Nav Gill ◽

Christopher W. Toon ◽

Nicole Watson ◽

Anthony J. Gill

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Node Metastasis

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Sentinel Node Biopsy: Interpretation and Management of Patients With Immunohistochemistry-Positive Sentinel Nodes and Those With Micrometastases

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.4667 ◽

2008 ◽

Vol 26 (5) ◽

pp. 698-702 ◽

Cited By ~ 73

Author(s):

Emiel J.T. Rutgers

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Sentinel Node ◽

Tumor Cells ◽

Clinical Decision Making ◽

Prognostic Significance ◽

Axillary Lymph ◽

Isolated Tumor Cells ◽

Sentinel Nodes ◽

Node Metastasis

The sentinel node procedure is an adequate tool to identify lymph node metastasis in breast cancer. Sentinel nodes are generally examined with greater attention mainly to exclude, as reliably as possible, lymph node metastasis. To achieve this, many protocols are used, resulting in different rates of micrometastasis or isolated tumor cells encountered. Since the prognostic significance of isolated tumor cells or micrometastasis in the sentinel nodes, and the risk of further axillary lymph node involvement in patients with isolated tumor cells, is uncertain and at most limited, these findings may pose difficulties for clinicians in clinical decision making. Protocols that identify lymph node metastasis, from which the clinical relevance is known, are warranted. Unnecessary lymph node dissections should be avoided.

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