D3 lymph node dissection improves the survival outcome in patients with pT2 colorectal cancer

Abstract

Background: The extent of lymphadenectomy in patients with pT2 colorectal cancer (CRC) remains controversial. This study aimed to elucidate the effects of D3 and D2 lymph node dissection (LND) on survival in patients diagnosed with pT2 CRC.Methods: This was a retrospective cohort study from a high-volume cancer center in Japan. From April 2007 to December 2020, 6,273 patients with primary CRC were included in the study; among these, 616 patients diagnosed with pT2 CRC underwent radical colorectal resection. Propensity score matching (PSM) was applied to balance potential confounding factors and a total of 104 matched pairs were extracted from the entire cohort. Independent risk factors associated with prognosis were determined by Cox regression analysis. The main outcome measures were overall survival (OS) and cancer-speci c survival (CSS).Results: Before PSM, there was a statistically signi cant difference across the cohort in OS and CSS (p=0.000 and 0.013) between D3 and D2 LND groups; the estimated hazard ratio (HR) was 2.2 (95% con dence interval (CI), 1.1-4.4, p=0.031) for OS in the D3 LND and 4.4 (95% CI, 1.7 to 11, p=0.0027) for CSS (p=0.013). There was also a signi cant difference (p=0.024) in OS between the D3 and D2 LND groups in the matched cohort, with an estimated HR for OS of 3.3 (95% CI, 1.2 to 9.1, p=0.024) and an estimated HR for CSS of 7.2 (95% CI, 1.6 to 33, p=0.011). Conclusions:D3 LND had a signi cant survival advantage in the treatment of pT2 colorectal cancer. The results of this study provide a theoretical basis for the application of D3 LND in radical surgery for pT2 colorectal cancer.LND to the origin of the main supplying artery has been recognized [2]. However, the optimal range of LND for pT2 colorectal cancer remains unclear [1,5].Propensity score matching (PSM) has been widely used in recent clinical studies to minimize the in uence of confounding variables between study groups [6]. In this context, the objective of this study was to evaluate the effect of D3 LND on the long-term prognosis of patients with pT2 CRC. Patients And Methods De nition of T-stage and extent of lymph node dissectionThis study was conducted according to the 7th Edition of the Japanese Colorectal Cancer Protocol. The tumor (T) stage and extent of LND were classi ed. Two Japanese pathologists examined all postoperative specimens. Stage pT2 is de ned as tumor in ltration into but not extending beyond the muscularis propria (Fig. 1). The mesenteric lymph nodes from the tissues surrounding the tumor to the root of the nutrient vessels supplying the tumor are de ned as the regional lymph nodes, and are divided into pericolic lymph nodes, intermediate lymph nodes, and apical lymph nodes (Fig. 2). Dissection to the level of the pericolic lymph nodes is de ned as D1 LND; dissection of both pericolic and intermediate lymph nodes is de ned as D2 LND; and dissection of pericolic, intermediate, and apical lymph nodes is de ned as D3 LND.According to the depth of tumor invasion, adequate resection of CRC requires resectio...

D3 lymph node dissection improves survival outcomes in patients with cT2 colorectal non-well-differentiated adenocarcinoma

“…Propensity score matching (PSM) has been widely used in recent clinical studies to minimize effects of confounding variables across study groups [3]. In a previous study of ours, we observed better long-term survival after D3 LND than after D2 LND in patients with pT2 tumors with PSM [4], although in practice, surgeons cannot gauge exact depths of invasion before surgery. It is therefore critical to determine if patients with cT2 CRC should undergo D3 or D2 LND.…”

Occurrence and Prognosis of Mixed Subtype Adenocarcinoma and Adeno-Squamous Carcinoma in Esophageal Cancer

“…The reported incidence of EAM and EASC is limited, with a primary focus on the incidence of colorectal AM [8] or pancreatic ASC [23]. Both EAM and EASC are rare subtypes of esophageal cancer, with extensive research conducted to report the clinical and pathological characteristics of gastric and colorectal AM.…”

“…Both EAM and EASC are rare subtypes of esophageal cancer, with extensive research conducted to report the clinical and pathological characteristics of gastric and colorectal AM. However, there is limited literature on esophageal AM [8,24]. The prognosis of both types is currently unclear, and this study aims to promote a better understanding of the incidence and survival rates of esophageal AM and EASC.…”

“…Mixed adenocarcinoma (AM) is an uncommon adenocarcinoma subtype characterized by the coexistence of conventional adeno-carcinomatous components with areas of differentiation [7,8], often featuring a combination of glandular and poorly cohesive or signet ring cells [9,10]. While AM is a rare but highly aggressive histological subtype in colorectal cancer, it has been identified as an independent adverse prognostic marker for overall survival [11].…”