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

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.

Prediction model for ypΝ status after preoperative chemoradiotherapy in patients with rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 513-513 ◽  
Author(s):  
Eunjin Jwa ◽  
Jong Hoon Kim ◽  
Seungbong Han ◽  
Jin-hong Park ◽  
Jin Cheon Kim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Prediction Model ◽  
Cancer Patients ◽  
Local Excision ◽  
Preoperative Chemoradiotherapy ◽  
Lymph Node Status ◽  
Node Metastasis ◽  
Nodal Stage

513 Background: Pelvic lymph node status after preoperative chemoradiotherapy (CRT) is not only an important indicator for oncologic outcome but critical information to determine the type of a subsequent surgical resection (i.e. curative surgery or local excision) in patients with locally advanced rectal cancer. The purpose of this study is to develop a nomogram to predict the lymph node status after preoperative CRT in rectal cancer patients whose ypT information is available. Methods: Using logistic regression analyses, we constructed a prediction model to predict the probability of lymph node metastasis after preoperative CRT in a cohort of 1,099 patients with rectal cancer treated with preoperative CRT and total mesorectal excision (TME) from 2007 to 2011. The model was internally validated for discrimination and calibration using bootstrap resampling. Results: Pretreatment clinical nodal stage, distant metastasis, pre- and post-treatment tumor differentiation, and ypT stage were reliable predictors for lymph node metastasis after preoperative CRT. The nomogram developed using these parameters represents a valid and accurate method for predicting lymph node metastasis after preoperative CRT in rectal cancer patients. (c-index: 0.75) Patients with low pretreatment nodal stage, nonmetastatic, and well differentiated rectal adenocarcinoma downstaged to ypT0-1 after preoperative CRT will have low chance of pelvic lymph node involvement. Conclusions: Our model is expected to assist clinicians in quantifying the benefit of radical resection and finding out the patient group who can be treated with local excision after preoperative CRT for rectal cancer.

Prognostic Significance of Tumor Deposits in Combination with Lymph Node Metastasis in Stage III Colon Cancer: A Propensity Score Matching Study

2020 ◽  
Vol 86 (2) ◽  
pp. 164-170
Author(s):  
Peilin Zheng ◽  
Chen Lai ◽  
Weimin Yang ◽  
Zhikang Chen
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Propensity Score ◽  
Confidence Interval ◽  
Propensity Score Matching ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Node Metastasis

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.

scholarly journals Analysis of clinical and pathological factors in patients undergoing surgery for rectal cancer: a single-centre experience with 692 patients in China

2020 ◽  
Author(s):  
Liping Xu ◽  
Chi Zhang ◽  
Zhaoyue Zhang ◽  
Xinyu Tang ◽  
Qin Qin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Perineural Invasion ◽  
Radical Surgery ◽  
Node Metastasis ◽  
T Stage ◽  
Significant Difference ◽  
Tumour Location ◽  
Poorly Differentiated

Abstract Background: The management of rectal carcinoma has substantially evolved over the past two decades, so as AJCC staging and NCCN guidelines. The inherent relationships of pathologic factors warrant further study. The present study aimed to assess the associations of clinical and pathological factors in rectal cancer patients undergoing radical surgery.Methods: From October 2015 to February 2019, all rectal cancer patients treated with radical surgery without neoadjuvant therapy were identified. The analysis was performed with data obtained from the prospectively collected database. Predictive factors for lymph node metastasis were analysed.Results: In total, 692 patients with a median age of 61.64 years (range: 22-89) were included. There was no significant difference in onset age between male and female patients (61.75±11.10 vs 61.43±11.92, P=0.723).Tumour location (P=0.004), perineural invasion (PNI) (P=0.000), lymphovascular invasion (LVI) (P=0.000), tumour deposit (TD) (P=0.000), and differentiation grade (P=0.000) were significantly related to pathologic T stage in univariate analysis, while sex was not (p=0.192).Compared to patients with T1 disease, there was a significantly higher proportion of positive LVI in patients with stage T3 disease (P=0.011, OR=3.404, 95% CI: 1.319-8.787) but not in those with T2 (P=0.686, OR=0.804, 95% CI: 0.280-2.310) and T4 (P=0.063, OR=3.200, 95% CI: 0.941-10.886) disease. Compared to patients with T2 disease, there was a significantly higher proportion of perineural invasion in patients with stage T3 (P=0.000, OR=6.2376, 95% CI: 3.371-11.685) but not T4 (P=0.172, OR=2.309, 95% CI: 0.694-7.676) disease. Compared to patients with T1 disease, a significantly higher proportion of TDs occurred in patients with stage T3 (P=0.013, OR=6.106, 95% CI: 1.455-25.631) and stage T4 (P=0.019, OR=7.146, 95% CI: 1.378-37.044) but not stage T2 (P=0.435, OR=0.503, 95% CI: 0.089-2.824) disease. The overall incidence of lymph node metastasis was 44.9% (19.6% for T1, 23.6% for T2, 56.7% for T3, and 67.8% for T4). Patient age, sex, and tumour location did not significantly affect lymph node metastasis (LNM). The presence of LVI (OR=3.882, 95% CI=2.338-6.440, P=0.000), TD (OR=27.645, 95% CI=9.805-77.947, P=0.000), higher T stage (OR=1.969, 95% CI=1.471-2.635, P=0.000), and poorly differentiated histology (OR=2.255, 95% CI=1.544-3.293, P=0.000) were associated with a higher incidence of LNM on multivariate analysis. Perineural invasion (P=0.000) significantly affected LNM in univariate but not multivariate analysis (OR=1.213, 95% CI=0.734-2.003, P=0.452).Conclusion: There was no significant difference between male and female patients in onset age. Tumour location, PNI, LVI, TD, and differentiation grade were significantly related to pathologic T stage. Patients with the presence of LVI and TD, higher T stage, and poorly differentiated histology have a significantly higher chance of LNM.

scholarly journals Prognostic Value of the Distribution of Lymph Node Metastasis in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy

2021 ◽  
Vol 8 ◽  
Author(s):  
Bin Chen ◽  
Xing Liu ◽  
Yiyi Zhang ◽  
Jinfu Zhuang ◽  
Yong Peng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Lymph Node Metastasis ◽  
Prognostic Value ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Node Metastasis

Background: The objective of this study is to assess the prognostic value of lymph node metastasis distribution (LND) in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT).Methods: This study included 179 patients with pathological stage III LARC who underwent nCRT followed by radical surgery. LND was classified into three groups: LND1, lymph node metastasis at the mesorectum (140/179, 78.2%); LND2, lymph node metastasis along the inferior mesenteric artery trunk nodes (26/179, 14.5%); LND3, lymph node metastasis at the origin of the IMA (13/179, 7.3%). Clinicopathologic characteristics were analyzed to identify independent prognostic factors.Result: LND showed better stratification for 3-year DFS (LND1 66.8, LND2 50, and LND3 15.4%, P &lt; 0.01) compared to the ypN (3-year DFS: N1 59.9 and N2 60.3%, P = 0.34) and ypTNM (3-year DFS: IIIA 68.6%, IIIB 57.5%, and IIIC 53.5, P = 0.19) staging systems. Similar results were found for 3-year LRFS and DMFS. According to multivariate survival analysis, LND was shown to be an independent prognostic factor for DFS, LRFS, and DMFS in patients with positive lymph nodes (P &lt; 0.01, in all cases).Conclusion: LND is an independent prognostic factor in stage III rectal cancer after nCRT. LND can be used as a supplementary indicator for the ypTNM staging system in patients with LARC after nCRT.

scholarly journals The effect of lymph node metastasis on overall survival and disease-free survival in vulvar cancer patients

2020 ◽  
Vol 91 (2) ◽  
pp. 62-67
Author(s):  
Volkan Karataşlı ◽  
Selçuk Erkılınç ◽  
İlker Çakır ◽  
Behzat Can ◽  
Tuğba Karadeniz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Vulvar Cancer ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Metastasis ◽  
Disease Free

The mutational profile analysis of extramural vascular invasion in rectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15128-e15128
Author(s):  
Mingtian Wei ◽  
Yane Song ◽  
Xiangbing Deng ◽  
Lijia Wu ◽  
Wenjian Meng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Survival Analysis ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Vascular Invasion ◽  
Molecular Mechanisms ◽  
Negative Group ◽  
Kras Mutations ◽  
Node Metastasis

e15128 Background: Extramural vascular invasion(EMVI) is a known independent predictor of poor prognosis in rectal cancer, as evidenced by a higher risk of developing metastases and a shorter DFS compared with negative tumours. However, the molecular mechanisms of EMVI genesis remains unclear. The objective of this study is to clarify the distinct molecular characterization of EMVI-positive tumours from that of EMVI-negative tumours. Methods: DNA was extracted from FFPE tumor specimens and matched normal tissue samples from rectal cancer patients who underwent surgical resection. Comprehensive genomic profiling analysis was performed using a 2.41M size panel covering exon regions of 1,622 genes based on next generation sequencing assay. Somatic Mutations were analyzed to determine the difference of molecular features between EMVI-positive and EMVI-negative patients. Results: In this retrospective study, a total of 48 rectal cancer patients without distant metastases were included: 17 patients in the EMVI-positive group and 31 patients in the EMVI-negative group. All the EMVI-postive patients had lymph node metastasis and 15 patients had lymph node metastasis in EMVI-negative group. Among all the tumours, the most frequently mutated genes were TP53, APC, KRAS, SMAD4, CHEK2, TCF7L2 and FBXW7. Mutations of TCF7L2 and CHEK2 were more frequently observed in EMVI-positive tumours than that in EMVI-negative tumours with p < 0.05. Survival analysis (Kaplan-Meier) indicated that patients with KRAS mutations(n = 9) had a shorter DFS than patients without KRAS mutations(n = 23) in patients with lymph node metastasis (p < 0.05). In addition, age was significantly associated with DFS according to the survival analysis (p < 0.05). Conclusions: Several possible candidate genes that may be helpful to characterize the distinct mutational profile of EMVI-positive tumours from EMVI-negative tumours were identified, which may be of great significance in disclosing the molecular mechanism underlying in EMVI initiation and progression. Expanded prospective cohorts are warranted to further elucidate these findings.

scholarly journals Long non-coding RNA XIST expression as a prognostic factor in human cancers: A meta-analysis

2019 ◽  
Vol 34 (4) ◽  
pp. 327-333
Author(s):  
Shuai Yin ◽  
Jiayu Dou ◽  
Guifang Yang ◽  
Fangfang Chen
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Distant Metastasis ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
High Expression ◽  
Xist Expression ◽  
Node Metastasis

A large number of literature has shown that high expression of X inactive-specific transcript (XIST) is associated with poor prognosis and metastasis of cancer in patients. However, most of this literature is limited by the small sample sizes and discrete outcomes. Therefore, a meta-analysis was performed to investigate the relation between XIST expression and tumor node metastasis (TNM) stage, lymph node metastasis, distant metastasis, and overall survival of cancer patients. We searched for literature in PubMed, Embase, and Web of Science. The pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to evaluate the association of XIST expression with prognosis and clinicopathological characteristics of cancer patients. Finally, a total of 14 articles involving 1123 patients were included in this meta-analysis. The results suggested that high expression of XIST has a significant relationship with a relatively poor overall survival for patients with malignant tumors (HR 1.82; 95% CI 1.32, 2.52; P = 0.0003). Moreover, high expression of XIST was significantly associated with poor TNM stage (OR 3.64; 95% CI 2.62, 5.07; P < 0.0001), lymph node metastasis (OR 2.39; 95% CI 1.65, 3.46; P < 0.0001) and distant metastasis (OR 2.84; 95% CI 1.90, 4.23; P < 0.0001). In conclusion, high expression of lncRNA XIST may be a predictive factor of poor prognosis in human cancers.

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