Prognostic value and characteristics of N1c colorectal cancer

Bouquot, Morgane; Creavin, Ben; Goasguen, N.; Chafaı̈, Najim; Tiret, Emmanuel; André, Thierry; Fléjou, Jean François; Parc, Yann; Lefèvre, Jérémie H.; Svrcek, Magali

doi:10.1111/codi.14289

Cited by 39 publications

(47 citation statements)

References 25 publications

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“…patients had a worse DFS that was not statistically significant to the old N2 classification (28.7% vs 42.7%; P = .644) and was significantly different to the previous N1 classification (28.7% vs 58.9%; P = .003). The incidence of TDs in the present study was similar to previous studies, 8,9,16,17 however, it was higher than a recently published review on TDs and N1c. 18 The results in the present study are supported by the use of standardized pathological reports that systematically mentioned TDs and other poor prognostic factors.…”

Section: Addition Of Tds With Ln Metastasis Countsupporting

confidence: 89%

“…6 N1c category represents 5% to 10% of rectal cancers 4,7 with TDs seen in around 20% of all adenocarcinomas. 8 TDs are associated with poor prognostic markers such as a high T stage (T3-T4 stage) 7,9 and a higher N stage. 10,11 60% of patients with stage IV disease have TDs 12 with a further 72% of CRC with PNI having TDs also.…”

Section: Introductionmentioning

confidence: 99%

“…However, most of these studies were retrospective, based on pathological specimens from pre-2010 before the reclassification of the TNM stage. 8 It has been suggested that TDs may have worse prognosis in rectal cancer compared with colon cancer, 9 although there a limited number of studies purely examining rectal cancer alone. Moreover, TDs identification after radiotherapy remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of tumor deposits in rectal cancer: A monocentric series of 505 patients

Benoit

Svrcek

Creavin

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: It has been suggested that tumor deposits (TDs) may have a worse prognosis in rectal cancer compared with colonic cancer. The aim of this study was to assess TDs prognosis in rectal cancer. Methods: Patients who underwent total mesorectum excision for rectal adenocarcinoma (2011-2016) were included. A case-matched analysis was performed to assess the accurate impact of TDs for each pN category after exclusion of synchronous metastasis. Results: A total of 505 patients were included. TDs were observed in 99 (19.6%) patients, (pN1c = 37 [7.3%]). TDs were associated with pT3-T4 stage (P = .037), synchronous metastasis (P = .003), lymph node (LN) invasion (P = .041), vascular invasion (P = .001), and perineural invasion (P < .001). TD was associated with a worse 3-year disease-free survival (DFS) among pN0 (51.2% vs 79.8%; P < .001); pN1 patients (35.2% vs 70.1%; P = .004) but not among pN2 patients (37.5% vs 44.7%; P = .499). After matching, pN1c patients had a worse 3-year DFS compared with pN0 patients (58.6% vs 82.4%; P = .035) and a tendency toward a worse DFS among N1 patients (40.1% vs 64.2%; P = .153). DFS was worse when one TD was compared with one invaded LN (40.8% vs 81.3%; P < .001). Conclusion: In rectal cancer, TDs have a metastatic risk comparable to a pN2 stage which may lead to changes in adjuvant treatment.

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Section: Addition Of Tds With Ln Metastasis Countsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic value of tumor deposits in rectal cancer: A monocentric series of 505 patients

Benoit

Svrcek

Creavin

et al. 2020

Journal of Surgical Oncology

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“…In addition, the CSS of N1c patients was significantly worse compared with N0 patients, confirming the application of the N1c category in LARC patients with neo‐CRT. Recently, Bouquot et al included 1122 colorectal patients to evaluate the impact of N1c category in both colon and rectal cancers . N1c category were identified only in 57 patients (24 colon cancers and 33 rectal cancers) and was associated with rectal cancer, advanced tumor stage (~90% T3‐T4), and synchronous metastases (40%).…”

Section: Discussionmentioning

confidence: 99%

Poor prognostic and staging value of tumor deposit in locally advanced rectal cancer with neoadjuvant chemoradiotherapy

et al. 2019

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Tumor deposit (TD) was associated with poor survival in colorectal cancer. However, its prognostic and staging value in locally advanced rectal cancer (LARC) patients following neoadjuvant chemoradiotherapy (neo‐CRT) is controversial. Four hundred and ninety‐five LARC patients following neo‐CRT and surgery were retrospectively analyzed. Univariate and multivariate analyses were performed using Kaplan‐Meier method and Cox proportional hazards regression in all lymph node (LN) ‐negative and LN‐positive patients. Next, we used three methods to classify the counts of LNs and TDs (oN, only LN counts; n1N, counts according to the N1c standards; n2N, total counts of LNs and TDs) to evaluate the impact of TD on N staging. TD‐positive patients were associated with more aggressive clinicopathological features. In multivariate analyses, TD was an independent poor prognostic factor of overall survival (OS), disease‐free survival (DFS), and local recurrence‐free survival in all patients. In LN‐negative patients, TD was an independent poor prognostic factor of OS, DFS and distant metastasis‐free survival (DMFS). In LN‐positive patients, TD has poor prognostic value only in patients with one positive LN. Three multivariate analyses according to three N staging methods showed that oN was not an independent prognostic factor, whereas n1N and n2N were independently associated with poor survival in OS, DFS and DMFS. The n2N method seemed to be better than n1N method. TD is an independent poor prognostic factor in LARC patients following neo‐CRT, especially in patients with no more than one positive LN. TD probably should be considered as one positive LN when performing N staging.

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“…Moreover, lymph nodes may be difficult to differentiate from tumour deposits when normal lymph node tissue has been completely replaced by tumour. Recent studies also indicate that tumour deposits (N1c) are associated with worse survival than metastatic lymph nodes when considering both types of lesions in isolation [ 9 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

et al. 2020

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Purpose To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. Trial registration Clinical Trials Identifier:NCT03846882.

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Prognostic value and characteristics of N1c colorectal cancer

Abstract: Our results indicate that N1c CRC patients should be included among high-risk patients for whom it is widely accepted that adjuvant chemotherapy should be considered.

Cited by 39 publications

References 25 publications

Prognostic value of tumor deposits in rectal cancer: A monocentric series of 505 patients

Prognostic value of tumor deposits in rectal cancer: A monocentric series of 505 patients

Poor prognostic and staging value of tumor deposit in locally advanced rectal cancer with neoadjuvant chemoradiotherapy

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

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