Prognosis Prediction for Stage II Colorectal Cancer by Fusing CT Radiomics and Deep Learning Features of Primary Lesion and Peripheral Lymph Nodes

Background. Evaluation of lymph node status is critical in colorectal carcinoma (CRC) treatment. However, as patients with node involvement may be incorrectly classified into earlier stages if the examined lymph node (ELN) number is too small and escape adjuvant therapy, especially for stage II CRC. The aims of this study were to assess the impact of the ELN on the survival of patients with stage II colorectal cancer and to determine the optimal number. Methods. Data from the US Surveillance, Epidemiology, and End Results (SEER) database on stage II resected CRC (1988-2013) were extracted for mathematical modeling as ELN was available since 1988. Relationship between ELN count and stage migration and disease-specific survival was analyzed by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS (Locally Weighted Scatterplot Smoothing) smoother, and the structural break points were determined by the Chow test. An independent cohort of cases from 2014 was retrieved for validation in 5-year disease-specific survival (DSS). Results. An increased ELN count was associated with a higher possibility of metastasis LN detection (OR 1.010, CI 1.009-1.011, p<0.001) and better DSS in LN negative patients (OR 0.976, CI 0.975-0.977, p<0.001). The cut-off point analysis showed a threshold ELN count of 21 nodes (HR 0.692, CI 0.667-0.719, p<0.001) and was validated with significantly better DSS in the SEER 2009 cohort CRC (OR 0.657, CI 0.522-0.827, p<0.001). The cut-off value of the ELN count in site-specific surgeries was analyzed as 20 nodes in the right hemicolectomy (HR 0.674, CI 0.638-0.713, p<0.001), 19 nodes in left hemicolectomy (HR 0.691, CI 0.639-0.749, p<0.001), and 20 nodes in rectal resection patients (HR 0.671, CI 0.604-0.746, p<0.001), respectively. Conclusions. A higher number of ELNs are associated with more-accurate node staging and better prognosis in stage II CRCs. We recommend that at least 21 lymph nodes be examined for accurate diagnosis of stage II colorectal cancer.

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Analysis on the correlation between number of lymph nodes examined and prognosis in patients with stage II colorectal cancer

Medical Oncology ◽

10.1007/s12032-012-0371-0 ◽

2013 ◽

Vol 30 (1) ◽

Cited By ~ 7

Author(s):

Zhang Xingmao ◽

Wang Hongying ◽

Zhou Zhixiang ◽

Wang Zheng

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Stage Ii ◽

Stage Ii Colorectal Cancer

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Size and number of examined lymph nodes impacts outcome in patients with stage II colorectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.14_suppl.3507 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 3507-3507 ◽

Cited By ~ 4

Author(s):

L. Chirieac ◽

Y. Suehiro ◽

A. Niemisto ◽

I. Shmulevich ◽

S. Lunagomez ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Stage Ii ◽

Stage Ii Colorectal Cancer

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Detection of Mutated K12-ras in Histologically Negative Lymph Nodes as an Indicator of Poor Prognosis in Stage II Colorectal Cancer

Clinical Colorectal Cancer ◽

10.3816/ccc.2001.n.011 ◽

2001 ◽

Vol 1 (2) ◽

pp. 110-116 ◽

Cited By ~ 23

Author(s):

Robert T. Belly ◽

Joseph D. Rosenblatt ◽

Michele Steinmann ◽

Jacqueline Toner ◽

Jianbo Sun ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Poor Prognosis ◽

Stage Ii ◽

Stage Ii Colorectal Cancer ◽

Negative Lymph Nodes

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Lymph Node Morphology in Stage II Colorectal Cancer

10.1101/2020.04.21.054205 ◽

2020 ◽

Author(s):

Annabelle Greenwood ◽

John Keating ◽

Diane Kenwright ◽

Ali Shekouh ◽

Alex Dalzell ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lymph Node ◽

Lymph Nodes ◽

B Cell ◽

Stage Ii ◽

Cell Compartments ◽

Stage Ii Colorectal Cancer ◽

Draining Lymph Node ◽

Draining Lymph Nodes

ABSTRACTBackgroundColorectal cancer is one of the leading causes of cancer-associated morbidity and mortality worldwide. The local anti-tumour immune response is particularly important for patients with stage II where the tumour-draining lymph nodes have not yet succumbed to tumour spread. The lymph nodes allow for the expansion and release of B cell compartments such as primary follicles and germinal centres. A variation in this anti-tumour immune response may influence the observed clinical heterogeneity in stage II patients.AimThe aim of this study was to explore tumour-draining lymph node histomorphological changes and tumour pathological risk factors including the immunomodulatory microRNA-21 (miR-21) in a small cohort of stage II CRC.MethodsA total of 23 stage II colorectal cancer patients were included. Tumour and normal mucosa samples were analysed for miR-21 expression levels and B-cell compartments were quantified from Haematoxylin and Eosin slides of lymph nodes. These measures were compared to clinicopathological risk factors such as perforation, bowel obstruction, T4 stage and high-grade.ResultsWe observed greater follicle density in patients with a lower tumour T stage and higher germinal centre density in patients with higher pre-operative carcinoembryonic antigen levels. Trends were also detected between tumours with deficiency in mismatch repair proteins, lymphatic invasion and both the density and size of B-cell compartments. Lastly, elevated tumour miR-21 was associated with decreased follicle and germinal centre size.ConclusionVariation in B-cell compartments of tumour-draining lymph nodes is associated with clinicopathological risk factors in stage II CRC patients.What does this paper add to the literature?This study demonstrates the variability of tumour draining lymph node morphological features in stage II CRC patients. This provides new scope for biomarker discovery in stage II CRC patients which is a research priority for this patient group.

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