Overall Survival of Stage III Colon Cancer with Only One Lymph Node Metastasis Is Independently Predicted by Preoperative Carcinoembryonic Antigen Level and Lymph Node Sampling Status

Tumor deposits in colon cancer are related to poor prognosis, whereas the prognostic power of tumor deposits in combination with lymph node metastasis (LNM) is controversial. This study aimed to compare the overall survival between LNM alone and LNM in combination with tumor deposits, and to verify whether the number of tumor deposits can be considered LNM in patients with both LNM and tumor deposits in stage III colon cancer by propensity score matching (PSM). Patients carrying resected stage III adenocarcinoma of colon cancer were identified from the Surveillance, Epidemiology, and End Results database (2010–2015). The Kaplan-Meier method, Cox proportional hazard models and PSM were used. On the whole, 23,168 patients (20,451 (88.3%) with only LNM and 2,717 (11.7%) with both LNM and tumor deposits) were selected. After undergoing PSM, patients with both LNM and tumor deposits showed worse overall survival (hazard ratio = 1.33, 95% confidence interval: 1.20–1.47, P < 0.001). After the number of tumor deposits was added with that of positive regional lymph nodes, patients with both LNM and tumor deposits seemed to have prognostic implications similar to those with LNM alone (hazard ratio = 1.02, 95% confidence interval: 0.93–1.12, P = 0.66). The simultaneous presence of LNM and tumor deposits, as compared with the presence of only LNM, had an association with a worse outcome. Tumor deposits should be considered as LNM in patients with both tumor deposits and LNM in stage III colon cancer.

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Distribution of lymph node metastasis is a prognostic index in patients with stage III colon cancer

Surgery ◽

10.1016/j.surg.2005.09.004 ◽

2006 ◽

Vol 139 (4) ◽

pp. 516-522 ◽

Cited By ~ 44

Author(s):

Hirotoshi Kobayashi ◽

Hideki Ueno ◽

Yojiro Hashiguchi ◽

Hidetaka Mochizuki

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Prognostic Index ◽

Stage Iii ◽

Stage Iii Colon Cancer ◽

Node Metastasis

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Preoperative Serum Carcinoembryonic Antigen Level as a Prognostic Factor for Recurrence and Survival After Curative Resection Followed by Adjuvant Chemotherapy in Stage III Colon Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-016-5613-5 ◽

2016 ◽

Vol 24 (1) ◽

pp. 227-235 ◽

Cited By ~ 12

Author(s):

Chang Gon Kim ◽

Joong Bae Ahn ◽

Minkyu Jung ◽

Seung Hoon Beom ◽

Su Jin Heo ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Prognostic Factor ◽

Carcinoembryonic Antigen ◽

Curative Resection ◽

Stage Iii ◽

Antigen Level ◽

Stage Iii Colon Cancer ◽

Preoperative Serum ◽

Serum Carcinoembryonic Antigen

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A Prognostic Model To Predict Survival In Stage III Colon Cancer Patients Based on Histological Grade, Preoperative Carcinoembryonic Antigen Level and the Neutrophil Lymphocyte Ratio

Asian Pacific Journal of Cancer Prevention ◽

10.7314/apjcp.2015.16.2.747 ◽

2015 ◽

Vol 16 (2) ◽

pp. 747-751 ◽

Cited By ~ 3

Author(s):

Zhi-Jun Wuxiao ◽

Hai-Yan Zhou ◽

Ke-Feng Wang ◽

Xiao-Qin Chen ◽

Xin-Bao Hao ◽

...

Keyword(s):

Colon Cancer ◽

Carcinoembryonic Antigen ◽

Cancer Patients ◽

Prognostic Model ◽

Histological Grade ◽

Stage Iii ◽

Antigen Level ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Stage Iii Colon Cancer

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Stratification of Stage III colon cancer may identify a patient group not requiring adjuvant chemotherapy

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-020-03381-w ◽

2020 ◽

Author(s):

Yasir G. Malik ◽

Lars Gustav Lyckander ◽

Jonas C. Lindstrøm ◽

Olof Vinge-Holmquist ◽

Ariba E. Sheikh ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Vascular Invasion ◽

Lymph Node Involvement ◽

Stage Iii ◽

Stage Iii Colon Cancer ◽

Node Involvement

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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Extracapsular Extension Does Not Decrease Overall Survival in Rectal Cancer Patients with Lymph Node Metastasis Following Neoadjuvant Chemoradiotherapy

Gastroenterology Insights ◽

10.3390/gastroent11020004 ◽

2020 ◽

Vol 11 (2) ◽

pp. 11-19

Author(s):

Leonardo Lino-Silva ◽

Carmen Sánchez-Acosta ◽

Rosa Salcedo-Hernández ◽

César Zepeda-Najar

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Cancer Patients ◽

Perineural Invasion ◽

Neoadjuvant Chemoradiotherapy ◽

Stage Iii ◽

Node Metastasis ◽

Nodal Stage

Background. The Tumor-Node-Metastasis system does not include additional prognostic factors present in the Lymph Node Metastasis (LNM) such as extra-capsular extension (ECE), which is associated with decreased survival. There are not studies addressing this topic in rectal cancer patients with preoperative chemoradiotherapy (nCRT) and total mesorectal excision (TME). Aim. We aimed to examine the survival influence of ECE in patients with stage III rectal cancer who received nCRT followed by surgery. Methods. A retrospective study of 126 patients prospectively collected with rectal cancer in clinical stage III rated with nCRT and TME from 2010 to 2015 was performed. Results. In total, 71.6% of cases had 1 to 3 lymph node metastases, most tumors were grade 2 (52.4%), 25.4% had good pathologic response, 77.8% had a good quality TME, and the median tumor budding count was 4/0.785 mm2. Forty-four (34.9%) patients had ECE+, which was associated with a higher nodal stage (pN2), perineural invasion and a higher lymph node retrieval. The factors associated with the survival were a higher pathologic T stage, higher pathological N stage, high-grade tumors, and perineural invasion. The ECE did not decrease the 5–year survival with a similar median survival (86.5 months for the ECE+ group vs. 84.1 for the ECE–). Conclusion. Our results demonstrate that ECE has no impact on overall survival in rectal cancer patients who received nCRT and this was independent of nodal stage or number of lymph nodes examined.

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