Prognostic significance of number versus location of positive mesenteric nodes in stage iii colon cancer |
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| Institution: | 1. Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan;2. Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium;3. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Japan;4. Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Belgium;1. Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands;2. Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands;3. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;4. Department of Radiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands;5. Department of Surgery, Reinier de Graaf Group, Delft, the Netherlands;1. University of Turin. Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital (S.L.U.H.), Regione Gonzole 10, 10049, Orbassano, Turin, Italy;2. University of Turin, Department os Surgical Sciences, Unit of General Surgery 2U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy;3. Unit of Clinical Epidemiology, AOU Città della Salute e della Scienza di Torino and Centro di Riferimento per l’Epidemiologia e la Prevenzione Oncologica in Piemonte (CPO), Corso Bramante 88, 10126, Turin, Italy;4. University of Eastern Piedmont, Department of Health Sciences, General Surgery Unit Ospedale Maggiore della Carita, Corso Mazzini 18, 28100, Novara, Italy;5. Unit of General and Oncological Surgery, Department of Surgery, ASO SS Croce e Carle, V Coppino 26, 12100, Cuneo, Italy;6. Unit of General Surgery, Ospedale S Giovanni Bosco, Piazza del Donatore di Sangue 3, 10154, Turin, Italy;7. Department of General Surgery, Ospedale degli Infermi di Biella, Via dei Ponderanesi 2, 13900, Ponderano, Biella, Italy;8. Department of General and Oncological Surgery, Ospedale Umberto I di Torino (Mauriziano), Corso Turati 62, 10128, Turin, Italy;9. University of Turin, Department os Surgical Sciences, Unit of Digestive and Oncological Surgery 1U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy;1. ESSO Clinical Research Committee, Brussels, Belgium;2. Charité Comprehensive Cancer Center, Berlin, Germany;3. Hospital Universitario de Fuenlabrada, Madrid, Spain;4. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden;5. Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands;6. Centre Léon Bérard, Lyon, France;7. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria;8. Dept. of General HPB and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium;9. Social Medical Center South, HPB Center Vienna Clincs, Vienna, Austria;10. Frankfurt University Hospital, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Frankfurt/Main, Germany;11. Universitätsmedizin Mannheim, Mannheim, Germany;12. Leiden University Medical Center, Leiden, Netherlands;13. Aintree University Hospital NHS Trust, Liverpool, United Kingdom;14. Oncology Institute of Vojvodina, Sremska Kamenica, Universty of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;15. Hyogo College of Medicine, Hyogo, Japan;p. EORTC, Brussels, Belgium;q. Gustave Roussy, Université Paris Saclay, Villejuif, France;r. Institut Bergonié, Université de Bordeaux, Bordeaux, France |
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| Abstract: | IntroductionDebate persists on the ideal extent of lymphadenectomy for colon cancer (CC). Specifically, it is unknown whether the anatomical location of positive lymph nodes (LN) has any independent prognostic significance. We assessed the prognostic value of positive LN location in stage III CC patients who underwent extensive (D3) lymphadenectomy.MethodsPatients from Kanagawa Cancer Center, Japan, who underwent D3 dissection for CC from 2000 to 16 were analyzed. Mesenteric LN were classified according to location as paracolic (L1), intermediate (L2), or central (L3). Recurrence-free survival (RFS) and the corresponding hazard function were evaluated with their trends over the L groups. Multivariate Cox models were used to evaluate the association of LN location with RFS.ResultsFour hundred forty-six stage III patients were analyzed. The mean number of examined/positive nodes per patient was 42.5/2.6 in L1 (n = 310), 40.9/4.8 in L2 (n = 111), and 44.0/9.8 in L3 (n = 25). RFS was worse for L3 vs. L2 (HR: 2.00, 95%CI 1.05–3.75], p = 0.034) and for L3 vs. L1 (2.62 1.45–4.71], p = 0.001), but not significantly different between L2 and L1 (1.32 0.89–1.5], p = 0.17). In a multivariate model adjusting for age, tumor size, and number of lymph nodes harvested T-stage (p < 0.001), adjuvant therapy (p < 0.0038), lymphatic invasion (p = 0.023), and LNR (p = 0.038) were significantly associated with RFS, but not L level or tumor location.ConclusionThe anatomical location of invaded LN does not significantly correlate with RFS in CC, after adjusting for potential confounders. Central LN are infrequently invaded and confer a worse RFS. |
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| Keywords: | Central lymph node Colon cancer Location of lymph node Lymph node ratio |
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