Prognostic Factors of Patients with Left-sided Obstructive Colorectal Cancer: Post-hoc Analysis of a Retrospective Multi-center Study in the Japan Colonic Stent Safe Procedure Research Group

Abstract Background There are many reports on the choice of treatment and prognosis of left-sided obstructive colorectal cancer; only few studies focus on the prognostic factors of LOCRC. Therefore, we analyzed the prognostic factors of left-sided obstructive colorectal cancer by post-hoc analysis of a retrospective multicenter study in the Japan Colonic Stent Safe Procedure Research Group. Methods This study was conducted as a post-hoc analysis of a retrospective multi-center observational study which enrolled a total of 301 patients, with the aim of investigating prognostic factors for relapse-free survival. The relationships among sex, age, decompression for bridge to surgery, depth of invasion, lymph node metastasis, postoperative complications, adjuvant chemotherapy, carcinoembryonic antigen, carbohydrate antigen 19 − 9, neutrophil-to-lymphocyte ratio, and relapse-free survival were examined. Results T3 of depth of invasion, negative postoperative complication (grade 0–1 of Clavien-Dindo classification), and administration of adjuvant chemotherapy (in Stage III) indicated a significantly good prognosis using Cox’s univariate analyses. Lymph node metastasis was not selected as a prognostic factor. Then, excluding patients with < 12 harvested lymph nodes, which may indicate stage migration, lymph node metastasis was also determined to be a prognostic factor. Using Cox’s multivariate analysis, depth of invasion, lymph node metastasis (excluding N0 cases with < 12 harvested lymph nodes), and adjuvant chemotherapy (all cases) were found to be prognostic factors. Conclusions In left-sided obstructive colorectal cancer, depth of invasion, lymph node metastasis and adjuvant chemotherapy were found to be prognostic factors, and patients with < 12 dissected lymph nodes could cause stage migration. This may result in disadvantages, such as not being able to receive adjuvant chemotherapy.

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The role of microvessel density, lymph node metastasis, and tumor size as prognostic factors of distant metastasis in colorectal cancer

Oncology Letters ◽

10.3892/ol.2017.5959 ◽

2017 ◽

Vol 13 (6) ◽

pp. 4327-4333 ◽

Cited By ~ 8

Author(s):

Tomonari Cho ◽

Eisuke Shiozawa ◽

Fumihiko Urushibara ◽

Nana Arai ◽

Toshitaka Funaki ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Distant Metastasis ◽

Microvessel Density ◽

Tumor Size ◽

Node Metastasis

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Predictive relevance of lymphovascular invasion in T1 colorectal cancer before endoscopic treatment

Endoscopy International Open ◽

10.1055/s-0043-117952 ◽

2017 ◽

Vol 05 (12) ◽

pp. E1278-E1283 ◽

Cited By ~ 3

Author(s):

Kazuya Inoki ◽

Taku Sakamoto ◽

Hiroyuki Takamaru ◽

Masau Sekiguchi ◽

Masayoshi Yamada ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Endoscopic Treatment ◽

Lymphovascular Invasion ◽

Lesion Size ◽

Depth Of Invasion ◽

Predictive Risk Factor ◽

Node Metastasis ◽

Younger Age

Abstract Background and aim The depth of tumor invasion is currently the only reliable predictive risk factor for lymph node metastasis before endoscopic treatment for colorectal cancer. However, the most important factor to predict lymph node metastasis has been suggested to be lymphovascular invasion rather than the depth of invasion. Thus, the aim of this study was to investigate the predictive relevance of lymphovascular invasion before endoscopic treatment. Methods The data on pT1 colorectal cancers that were resected endoscopically or surgically from 2007 to 2015 were retrospectively reviewed. The cases were categorized into two groups: positive or negative for lymphovascular invasion. The following factors were evaluated by univariate and multivariate analyses: age and sex of the patients; location, size, and morphology of the lesion; and depth of invasion. Results The positive and negative groups included 229 and 457 cases, respectively. Younger age (P < 0.01), smaller lesion size (P = 0.01), non-LST (LST: laterally spreading tumor) (P < 0.01), presence of depression (P < 0.01), and pT1b (P < 0.01) were associated with lymphovascular invasion. In multivariate analysis, younger age (comparing patients aged ≤ 64 years with those aged > 65 years, OR, 1.81; 95 %CI, 1.29 – 2.53), presence of depression (OR, 1.97; CI, 1.40 – 2.77), non-LST features (OR, 1.50; CI, 1.04 – 2.15), and pT1b (OR, 3.08; CI, 1.91 – 4.97) were associated with lymphovascular invasion. Conclusion Younger age, presence of depression, T1b, and non-LST are associated with lymphovascular invasion. Therefore, careful pathological diagnosis and surveillance are necessary for lesions demonstrating any of these four factors.

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The Predictive and Prognostic Factors in Patients with Gastric Cancer Accompanied by Gastric Outlet Obstruction

Gastroenterology Research and Practice ◽

10.1155/2020/6529563 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Hongliang Zu ◽

Huiling Wang ◽

Chunfeng Li ◽

Wendian Zhu ◽

Yingwei Xue

Keyword(s):

Gastric Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Size ◽

Outlet Obstruction ◽

Clinicopathological Features ◽

Depth Of Invasion ◽

Node Metastasis ◽

Distal Gastric Cancer

Purpose. This study is aimed at evaluating the clinicopathological features and prognostic significance of gastric outlet obstruction (GOO) in patients with distal gastric cancer. Methods. A retrospective review of 1564 individuals with distal gastric cancer from 2002 to 2010 was performed. In total, 157 patients had GOO. The clinicopathological features of the patients with GOO were compared with those of the patients without GOO. A Kaplan-Meier survival analysis and Cox proportional hazard model were used to assess the overall survival. Results. The patients with distal gastric cancer with GOO generally presented more aggressive pathologic features, a poorer nutritional status, more duodenal infiltration, and peritoneal dissemination than those with cancer without GOO. In the univariate analysis, curability, GOO, age, prealbumin, albumin, hemoglobin (Hb), the tumor size, the macroscopic type, lymph node metastasis, and the depth of invasion had a statistically significant influence on prognosis. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. Conclusions. Gastric cancer with GOO exhibits aggressive biological features and has poor outcomes. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. The gastric outlet status should be considered in the selection of surgical treatment methods for patients with gastric cancer.

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Prognostic factors in pulmonary metastasectomy and efficacy of repeat pulmonary metastasectomy from colorectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02076-3 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Masahiro Fukada ◽

Nobuhisa Matsuhashi ◽

Takao Takahashi ◽

Yoshihiro Tanaka ◽

Naoki Okumura ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Risk Ratio ◽

Mediastinal Lymph Node ◽

Univariate Analysis ◽

Pulmonary Metastasectomy ◽

Mediastinal Lymph Node Metastasis ◽

Node Metastasis

Abstract Background The rate of pulmonary metastasectomy from colorectal cancer (CRC) has increased with recent advances in chemotherapy, diagnostic techniques, and surgical procedures. The purpose of this study was to investigate the prognostic factors for response to pulmonary metastasectomy and the efficacy of repeat pulmonary metastasectomy. Methods This study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital. Results The 3- and 5-year survival rates were 84.9% and 60.8%, respectively. Among the 126 patients, 26 (20.6%) underwent a second pulmonary metastasectomy for pulmonary recurrence after initial pulmonary metastasectomy. Univariate analysis of survival identified seven significant factors: (1) gender (p = 0.04), (2) past history of extra-thoracic metastasis (p = 0.04), (3) maximum tumor size (p = 0.002), (4) mediastinal lymph node metastasis (p = 0.02), (5) preoperative carcinoembryonic antigen (CEA) level (p = 0.01), (6) preoperative carbohydrate antigen 19-9 (CA19-9) level (p = 0.03), and (7) repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001). On multivariate analysis, only mediastinal lymph node metastasis (p = 0.02, risk ratio 8.206, 95% confidence interval (CI) 1.566–34.962) and repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001, risk ratio 0.054, 95% CI 0.010–0.202) were significant. Furthermore, in the evaluation of surgical outcomes, the safety of second pulmonary metastasectomy was almost the same as that of initial pulmonary metastasectomy. Conclusions Repeat pulmonary metastasectomy is likely to be safe and effective for recurrent cases that meet the surgical criteria. However, mediastinal lymph node metastasis was a significant independent prognostic factor for worse overall survival.

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Prognostic Factors in the Pulmonary Metastasectomy and Efficacy of the Repeat Pulmonary Metastasectomy from Colorectal Cancer

10.21203/rs.3.rs-60969/v1 ◽

2020 ◽

Author(s):

Masahiro Fukada ◽

Nobuhisa Matsuhashi ◽

Takao Takahashi ◽

Yoshihiro Tanaka ◽

Naoki Okumura ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Risk Ratio ◽

Mediastinal Lymph Node ◽

Pulmonary Metastasectomy ◽

Mediastinal Lymph Node Metastasis ◽

Node Metastasis ◽

Significant Difference

Abstract Background Pulmonary metastasectomy from colorectal cancer (CRC) has improved with recent advances in chemotherapy, diagnostic techniques, and surgical procedures. The purpose of this study was to investigate the prognostic factors of response to pulmonary metastasectomy and the efficacy of repeat pulmonary metastasectomy.Methods This study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital. Among these 126 patients, 47 cases (37.3%) had pulmonary re-recurrence after initial pulmonary metastasectomy, and 26 cases (20.6%) underwent the second pulmonary metastasectomy. ResultsThe 3- and 5- year survival rates of all 126 patients who underwent complete pulmonary metastasectomy were 84.9% and 60.8%, respectively. Univariate analysis in survival identified seven significant factors: 1) gender (p = 0.04), 2) past history of extra thoracic metastasis (p = 0.04), 3) maximum tumor size (p = 0.002), 4) hilar or mediastinal lymph node metastasis (p = 0.02), 5) preoperative carcinoembryonic antigen (CEA) level (p = 0.01), 6) preoperative carbohydrate antigen 19-9 (CA19-9) level (p = 0.03), and 7) repeat pulmonary metastasectomy for pulmonary re-recurrence (p < 0.001). On the multivariate analysis, only hilar or mediastinal lymph node metastasis (p = 0.02, risk ratio: 8.206, 95% confidence interval (CI): 1.566-34.962) and repeat pulmonary metastasectomy for pulmonary re-recurrence (p < 0.001, risk ratio: 0.054, 95% CI: 0.010-0.202) were significant. Furthermore, there was no significant difference in clinical and surgical characteristics between the initial and the second pulmonary metastasectomy except for intraoperative blood loss [10 (range 0-1130) mL vs 20 (range 0-220) mL, p = 0.008]. Conclusions Repeat pulmonary metastasectomy is likely to be safe and effective for re-recurrent cases that meet the indication. However, hilar or mediastinal lymph node metastasis was a significant independent prognostic factor of worse overall survival.

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Prognostic factors in the pulmonary metastasectomy and efficacy of the repeat pulmonary metastasectomy from colorectal cancer

10.21203/rs.3.rs-60969/v2 ◽

2020 ◽

Author(s):

Masahiro Fukada ◽

Nobuhisa Matsuhashi ◽

Takao Takahashi ◽

Yoshihiro Tanaka ◽

Naoki Okumura ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Risk Ratio ◽

Mediastinal Lymph Node ◽

Pulmonary Metastasectomy ◽

Mediastinal Lymph Node Metastasis ◽

Node Metastasis ◽

Significant Difference

Abstract Background The rate of pulmonary metastasectomy from colorectal cancer (CRC) has increased with recent advances in chemotherapy, diagnostic techniques, and surgical procedures. The purpose of this study was to investigate the prognostic factors for response to pulmonary metastasectomy and the efficacy of repeat pulmonary metastasectomy.Methods This study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital. Results The 3- and 5- year survival rates were 84.9% and 60.8%, respectively. Among the 126 patients, 47 (37.3%) had pulmonary recurrence after initial pulmonary metastasectomy, and 26 (20.6%) underwent a second pulmonary metastasectomy. Univariate analysis of survival identified seven significant factors: 1) gender (p = 0.04), 2) past history of extra-thoracic metastasis (p = 0.04), 3) maximum tumor size (p = 0.002), 4) mediastinal lymph node metastasis (p = 0.02), 5) preoperative carcinoembryonic antigen (CEA) level (p = 0.01), 6) preoperative carbohydrate antigen 19-9 (CA19-9) level (p = 0.03), and 7) repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001). On multivariate analysis, only mediastinal lymph node metastasis (p = 0.02, risk ratio: 8.206, 95% confidence interval (CI): 1.566-34.962) and repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001, risk ratio: 0.054, 95% CI: 0.010-0.202) were significant. Furthermore, there was no significant difference in clinical and surgical characteristics between the initial and the second pulmonary metastasectomy except for intraoperative blood loss. Conclusions Repeat pulmonary metastasectomy is likely to be safe and effective for recurrent cases that meet the surgical criteria. However, mediastinal lymph node metastasis was a significant independent prognostic factor for worse overall survival.

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Analysis of the prognostic factors of triple-negative breast cancer and the clinical efficacy of postoperative radiotherapy in early cases.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e12502 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e12502-e12502

Author(s):

XT Cheng ◽

Y Zhang ◽

XX Zuo ◽

J Yang ◽

ML Dong ◽

...

Keyword(s):

Breast Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Node Metastasis ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Postoperative Radiotherapy ◽

Lymphocyte Ratio ◽

Node Metastasis

e12502 Background: To explore the prognostic value of pretherapeutic peripheral blood parameters and breast imaging-reporting and data system (BI-RADS) classification of triple-negative breast cancer (TNBC) and the effect of postoperative radiotherapy in early cases. Methods: A total of 278 TNBC patients’ medical records between January 2013 and December 2018 were retrospectively collected, including white blood cells, neutrophils, lymphocytes, platelets, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), serum tumor markers, BI-RADS classification, TNM staging and therapeutic methods. We used the log-rank test and Kaplan-Meier curves to assess the progression-free survival (PFS) of enrolled patients. Multivariate prognostic analysis was performed by the Cox regression model. Results: The median PFS of all 278 patients was 20 months (4-72 months) at the end of follow-up. Operable patients who obtained adjuvant chemotherapy had a better median PFS (20 vs 18.5 months, P= 0.018, HR = 5.943, 95% CI: 1.36-25.92) than those without. Lymph node metastasis (52%) and chest well relapse (28%) were the critical failure forms followed by other metastases (12% lungs, 9.3% bones, 4% liver and 2.7% brain) with p value less than 0.001. Multivariate analysis indicated that platelet counts > 113.5×109/L (p = 0.024), PLR ≤ 111.7 (p = 0.036) and CA15-3 ≤ 8.4 U/mL (p = 0.003) were significantly associated with the favourable prognosis of PFS in TNBC patients. Furthermore, BI-RADS of grade 2-4 had a better median PFS compared with grade of 5-6(20 vs 17.5 months, p = 0.008, HR = 2.154, 95% CI: 1.219-3.805). In subgroup analysis, forty-three early cases with pN1 stage earned additional benefits from postoperative radiotherapy in terms of low risk of distant metastasis and recurrence (p = 0.014). Residual tumor after surgery was another important factor of poor prognosis (p = 0.029). Conclusions: Adjuvant chemotherapy improved median PFS for operable TNBC patients and pretherapeutic platelets, PLR, CA15-3 and BI-RADS were the independent prognostic factors of survival. Lymph node metastasis and chest well relapse were the main patterns of treatment failure. Radiotherapy could reduce the risk of disease progression for postoperative patients with N1 stage.

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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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Comparison of Postoperative Adjuvant Chemotherapy and Concurrent Chemoradiotherapy for FIGO2018 Stage IIIC1 Cervical Cancer: A Retrospective Study

Medicina ◽

10.3390/medicina57060548 ◽

2021 ◽

Vol 57 (6) ◽

pp. 548

Author(s):

Masahiro Kagabu ◽

Takayuki Nagasawa ◽

Shunsuke Tatsuki ◽

Yasuko Fukagawa ◽

Hidetoshi Tomabechi ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Node Metastasis ◽

Radical Hysterectomy ◽

Concurrent Chemoradiotherapy ◽

Postoperative Adjuvant Chemotherapy ◽

Node Metastasis ◽

Significant Difference ◽

Advanced Stages

Background and Objectives: In October 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its classification of advanced stages of cervical cancer. The main points of the classification are as follows: stage IIIC is newly established; pelvic lymph node metastasis is stage IIIC1; and para-aortic lymph node metastasis is stage IIIC2. Currently, in Japan, radical hysterectomy is performed in advanced stages IA2 to IIB of FIGO2014, and concurrent chemoradiotherapy (CCRT) is recommended for patients with positive lymph nodes. However, the efficacy of CCRT is not always satisfactory. The aim of this study was to compare postoperative adjuvant chemotherapy (CT) and postoperative CCRT in stage IIIC1 patients. Materials and Methods: Of the 40 patients who had undergone a radical hysterectomy at Iwate Medical University between January 2011 and December 2016 and were pathologically diagnosed as having positive pelvic lymph nodes, 21 patients in the adjuvant CT group and 19 patients in the postoperative CCRT group were compared. Results: The 5 year survival rates were 77.9% in the CT group and 74.7% in the CCRT group, with no significant difference. There was no significant difference in overall survival or progression-free survival between the two groups. There was no significant difference between CT and CCRT in postoperative adjuvant therapy in the new classification IIIC1 stage. Conclusions: The results of the prospective Japanese Gynecologic Oncology Group (JGOG) 1082 study are pending, but the present results suggest that CT may be a treatment option in rural areas where radiotherapy facilities are limited.

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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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