Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection

Parnaby, Craig; Scott, Norman; Ramsay, George; Mackay, Craig; Samuel, Leslie; Murray, Graeme I.; Loudon, Malcolm

doi:10.1038/bjc.2015.211

Cited by 61 publications

(52 citation statements)

References 24 publications

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“…The reported rates of LVI in stage III CRC is, however, higher (20-30%) [24][25][26]. In stage IV CRC, Sternberg et al detected venous invasion with hematoxylin and eosin (H&E) and elastic fiber stain in 70% of the specimens [27].…”

Section: Discussionmentioning

confidence: 99%

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

et al. 2016

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Background: Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level. Materials and methods: Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012. Results: Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p < .001 for both). The three-year DFS and time to recurrence were 78% and 17%, respectively. Both LVI and PNI indicated worse outcome. In patients not receiving postoperative chemotherapy, the risks of recurrence after three years were 20% if LVI was seen and 22% if PNI was detected (p < .001 for both). In the absence of LVI and PNI, it was 13% and 12%, respectively. In a multivariate Cox regression analysis, patients with LVI (hazard ratio 1.44, 95% CI 1.09-1.90; p ¼ .011) and PNI (hazard ratio 1.80, 95% CI 1.34-2.43, p < .001) had significantly increased risks of recurrence. Conclusions: Stage II rectal cancer patients with LVI and PNI have an increased risk of recurrence which emphasizes the need to properly evaluate the role of adjuvant chemotherapy particularly in these subgroups.

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Section: Discussionmentioning

confidence: 99%

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

et al. 2016

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“…Lymph node involvement is one of the most significant However, recent studies have discussed the role of total numbers of lymph nodes retrieved, lymph node ratio, size and immune activation of lymph nodes 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of oncologic outcomes in colon cancer

et al. 2016

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PURPOSE:In this paper we report clinical variables on colon cancer series. Oncological outcomes were compared to low-income and high-income countries. METHODS:We analysed a prospective database of 51 colon cancer patients submitted to primary tumor resection between 2010 and 2011, showing clinical variables and oncologic outcomes.RESULTS: R0 resection obtained in 80.4%, 21.6% of patients was TNM stage IV, and only 13.7% showed TNM stage I. Diseasefree survival was 32 months, overall survival was 46 months, and the tumoral recurrence rate was 9.8%. Univariate analysis showed association of serum CEA levels ≥ 5 ng/dl (p= 0.004), presence of metastasis at diagnosis (p= 0.012), compromised surgical margins (p < 0.001) and poorer tumor differentiation (p= 0.041) to death. Multivariate analysis identified compromised surgical margins as an independent risk factor for death due to colon cancer (P=0.003; odds ratio=0.36; 95% confidence interval=0.004-0.33). Nowadays, 62.7% of patients are alive. CONCLUSION:Recurrence rate, disease-free survival and overall survival was similar to those observed in more developed countries.Serum CEA levels ≥ 5 ng/dl, the presence of metastasis at diagnosis, compromised surgical margins and poorer tumor differentiation were associated with death. A compromised surgical margin was the only independent risk factor for death.

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“…Surgical resection is the current major treatment for colon cancer. However, as tiny lesions may be overlooked during the surgery, the possibility of recurrence in patients with stage II/III colon cancers is approximately 20-50% (Clarizia et al, 2006;De Sousa E. Melo et al, 2013;Jin et al, 2014;Parnaby et al, 2015;Sun et al, 2015;Tan et al, 2015). DNA mismatch repair (MMR) proteins, such as hMLH1, hMSH2, hMSH6, and hPMS2, correct base mismatches that occur during DNA replication, and are therefore an important component in maintaining genomic stability (Erie and Weninger, 2014;Xu et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Association between expression of DNA mismatch repair genes and clinical features and prognosis of patients with radical resection of colon cancer

Wang¹,

et al. 2016

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the clinical significance of the expression of DNA mismatch repair (MMR) genes in patients subjected to radical surgical removal of colon cancer, as well as their correlation with disease prognosis. Ninety stage II and III colon cancer patients who received laparoscopic radical resection of colon cancer at our hospital were recruited in this study. The expression of hMLH1, hMSH2, hMSH6, and hPMS2 in the resected tumor tissues was examined by SP immunohistochemistry, in order to analyze the 2 J.B. Wang et al. Genetics and Molecular Research 15 (3): gmr.15038388 relationship between defective DNA MMR (dMMR) and the clinicopathological features and prognosis of colon cancer. Patients were followed up over a period of 5-35 months, and the Kaplan-Meier survival curve was plotted. dMMR was confirmed in 27 subjects (30.0%), among whom recurrence with metastasis and death was reported in 5 (18.5%) and 2 (7.4%) patients, respectively. The remaining 63 subjects displayed proficient DNA MMR (pMMR); among these, 19 (30.2%) and 7 (11.1%) recurrences with metastasis and death were reported, respectively. dMMR showed no significant correlation with gender, age, or therapeutic modality (P > 0.05), but was significantly correlated with the degree of differentiation, tumor location, number of resected lymph nodes, presence of ileus, and TNM stage (P < 0.05). The prognosis of patients with dMMR was better than that of patients with pMMR. dMMR serves as a biomarker for the prognosis of stage II/III colon cancers.

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Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection

Cited by 61 publications

References 24 publications

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

Comparative evaluation of oncologic outcomes in colon cancer

Association between expression of DNA mismatch repair genes and clinical features and prognosis of patients with radical resection of colon cancer

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