Prognostic significance of mesenteric tumor nodules in patients with stage III colorectal cancer

Abstract

BACKGROUND. Tumor nodules are occasionally found in adjacent mesentery of colorectal cancer specimens and are felt to reflect a worse prognosis. The clinical significance of mesenteric tumor nodules was investigated. METHODS. A review of 786 patients with stage III colorectal cancer referred between 1995 and 1999 was undertaken. TNM staging was standardized by considering mesenteric nodules separately and not assigning them to T or N categories. Survival analyses were performed. RESULTS. Mesenteric tumor nodules were found in 116 (14.8%) patients: 48 (41.4%) with colon cancer and 68 (58.6%) rectal cancer. Mean age at surgery was 63 years. Adjuvant chemotherapy was given to 84.8% of colon cancer patients. Two (2.9%) rectal cancer patients received neoadjuvant chemoradiation, and 63 (92.6%) received adjuvant therapy (chemotherapy and/or radiation). In the cohort with mesenteric nodules, the median time to progression was 23.1 months, the median 5‐year disease‐free survival was 35%, and the median overall survival (OS) was 47.9 months, with 44% OS at 5 years. In the 19 (16.4%) patients with mesenteric nodules and no lymph nodes the 5‐year OS was 60% (SEER stage II 5‐year survival 82.5%), whereas in 97 patients who were lymph node‐positive the 5‐year OS was 40% (SEER 5‐year survival stage IIIc 44.3%; stage IV 8.1%). CONCLUSIONS. In comparison to SEER survival data, the presence of mesenteric nodules appears to worsen the prognosis of any T/N0 disease to that of overall stage III disease. Mesenteric nodules with any T/N+ disease had prognosis similar to that of stage IIIC disease, but the prognosis was better than M1 disease. Cancer 2008. © 2007 American Cancer Society.

TNM staging system of colorectal carcinoma: surgical pathology of the seventh edition

“…164 Because of their heterogenous nature, these lesions have often been mixed with other types of venous 163,165,168,169 or lymphatic invasion, 163,169 lymph node metastasis, 163 nerve infiltration, 163,165,166,168e170 or otherwise nonspecified infiltration of the peri-visceral fat, 165,168,169 thus making it difficult to compare data from different studies and explaining differences in the hazard ratios between the different works. 164 Studies that considered as TDs all those metastatic occurrences not associated with lymph node involvement showed that these lesions, when grouped as a whole, have a prognosis similar to that of stage III disease, 168,171 thereby failing to provide evidence to Figure 15 Macroscopic view of the mesorectum. The protuberances indicated by the arrows correspond to the lateral lymph nodes that should be kept separated from the lymph nodes found within the mesorectum.…”

Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases

“…Studies that considered as tumor deposits all those metastatic occurrences not associated with lymph node involvement showed that these lesions, when grouped as a whole, have a prognosis similar to that of stage III disease, 14,15 thereby failing to provide an evidence basis to substantiate its inclusion in the TNM system. 16 Results of a recent meta-analysis based on survival involving 3714 patients, although confirming the consistent adverse prognostic value of tumor deposits, illustrated differences in the hazard ratios between the different studies.…”

Synchronous breast and colon cancer: factors determining treatment strategy

“…Satellite tumour deposits are considered the equivalent of nodal metastases (a lymph node replaced by tumour), even if they lack residual nodal architecture, and are staged as N1c disease in the absence of other nodal metastases, thus upstaging our patient's disease from N0 to N1c. The presence of these mesenteric tumour deposits is a strong adverse prognostic feature 7 8…”