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The Prognostic Role of Para-Aortic Lymph Nodes in Patients with Colorectal Cancer: Is It Regional or Distant Disease?

Lu HJ, Lin JK, Chen WS, Jiang JK, Yang SH, Lan YT, Lin CC, Liu CA, Teng HW - PLoS ONE (2015)

Bottom Line: Their prognostic value, however, remains inconclusive.Patients with visible PALNs had inferior overall survival compared to those without visible PALNs (5-year overall survival, 67% vs. 76%, P = 0.015).The prognostic model, which included LVI, pN+ status, preoperative serum CEA level, and the size of visible PALNs, could effectively distinguish the outcome of patients with visible PALNs.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology and Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Program in Molecular Medicine, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan.

ABSTRACT

Introduction: Visible para-aortic lymph nodes of ≥2 mm in size are common metastatic patterns of colorectal cancer (CRC) seen on imaging. Their prognostic value, however, remains inconclusive. We aimed to assess the prognostic role of visible para-aortic lymph nodes (PALNs).

Methods: Patients with confirmed pathologic diagnosis of CRC were enrolled. Correlations among clinicopathologic variables were analyzed using the χ2 test. The Cox proportional hazards model was applied for univariate and multivariate analyses. Survival was estimated using the Kaplan-Meier method and log-rank test. A prognostic model for visible PALNs in CRC patients was established.

Results: In total, 4527 newly diagnosed CRC patients were enrolled. Patients with visible PALNs had inferior overall survival compared to those without visible PALNs (5-year overall survival, 67% vs. 76%, P = 0.015). Lymphovascular invasion (LVI) (hazard ratio = 1.865, P = 0.015); nodal disease (pN+) status (hazard ratio = 2.099, P = 0.006); elevated preoperative serum carcinoembryonic antigen (CEA) levels (hazard ratio = 2.263, P < 0.001); and visible PALNs ≥10 mm (hazard ratio = 1.638, P = 0.031) were independent prognostic factors for patients with visible PALNs. If each prognostic factor scored one point, 5-year overall survival of lower- (prognostic score 0-1), intermediate- (prognostic score 2), and high- (prognostic score 3-4) risk groups were, 78%. 54%, and 25% respectively (P < 0.001).

Conclusions: The prognostic model, which included LVI, pN+ status, preoperative serum CEA level, and the size of visible PALNs, could effectively distinguish the outcome of patients with visible PALNs.

No MeSH data available.


Related in: MedlinePlus

Prognostic model for patients with visible PALNs.The prognostic scoring system scored one point for the presence of each of the following risk factors: lymphovascular invasion, pN+ status, serum carcinoembryonic antigen (CEA) level ≥10 ng/mL, and short axis diameter of PALNs ≥10 mm. According to the total prognostic score, patients with visible PALNs were divided into three groups: lower-risk (prognostic score of 0–1), intermediate-risk (prognostic score of 2), and high-risk (prognostic score of 3–4). 5-year OS of the lower-, intermediate-, and high-risk groups were, 78%, 54%, and 25% respectively (P <0.001).
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pone.0130345.g004: Prognostic model for patients with visible PALNs.The prognostic scoring system scored one point for the presence of each of the following risk factors: lymphovascular invasion, pN+ status, serum carcinoembryonic antigen (CEA) level ≥10 ng/mL, and short axis diameter of PALNs ≥10 mm. According to the total prognostic score, patients with visible PALNs were divided into three groups: lower-risk (prognostic score of 0–1), intermediate-risk (prognostic score of 2), and high-risk (prognostic score of 3–4). 5-year OS of the lower-, intermediate-, and high-risk groups were, 78%, 54%, and 25% respectively (P <0.001).

Mentions: Compared to patients without visible PALNs, the estimated OS of the lower-risk and high-risk groups were the same as the estimated OS of patients with early stage CRC and stage IV disease respectively. The estimated OS of the intermediate-risk group was between stage III and IVa CRC patients (Fig 4).


The Prognostic Role of Para-Aortic Lymph Nodes in Patients with Colorectal Cancer: Is It Regional or Distant Disease?

Lu HJ, Lin JK, Chen WS, Jiang JK, Yang SH, Lan YT, Lin CC, Liu CA, Teng HW - PLoS ONE (2015)

Prognostic model for patients with visible PALNs.The prognostic scoring system scored one point for the presence of each of the following risk factors: lymphovascular invasion, pN+ status, serum carcinoembryonic antigen (CEA) level ≥10 ng/mL, and short axis diameter of PALNs ≥10 mm. According to the total prognostic score, patients with visible PALNs were divided into three groups: lower-risk (prognostic score of 0–1), intermediate-risk (prognostic score of 2), and high-risk (prognostic score of 3–4). 5-year OS of the lower-, intermediate-, and high-risk groups were, 78%, 54%, and 25% respectively (P <0.001).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482546&req=5

pone.0130345.g004: Prognostic model for patients with visible PALNs.The prognostic scoring system scored one point for the presence of each of the following risk factors: lymphovascular invasion, pN+ status, serum carcinoembryonic antigen (CEA) level ≥10 ng/mL, and short axis diameter of PALNs ≥10 mm. According to the total prognostic score, patients with visible PALNs were divided into three groups: lower-risk (prognostic score of 0–1), intermediate-risk (prognostic score of 2), and high-risk (prognostic score of 3–4). 5-year OS of the lower-, intermediate-, and high-risk groups were, 78%, 54%, and 25% respectively (P <0.001).
Mentions: Compared to patients without visible PALNs, the estimated OS of the lower-risk and high-risk groups were the same as the estimated OS of patients with early stage CRC and stage IV disease respectively. The estimated OS of the intermediate-risk group was between stage III and IVa CRC patients (Fig 4).

Bottom Line: Their prognostic value, however, remains inconclusive.Patients with visible PALNs had inferior overall survival compared to those without visible PALNs (5-year overall survival, 67% vs. 76%, P = 0.015).The prognostic model, which included LVI, pN+ status, preoperative serum CEA level, and the size of visible PALNs, could effectively distinguish the outcome of patients with visible PALNs.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology and Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Program in Molecular Medicine, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan.

ABSTRACT

Introduction: Visible para-aortic lymph nodes of ≥2 mm in size are common metastatic patterns of colorectal cancer (CRC) seen on imaging. Their prognostic value, however, remains inconclusive. We aimed to assess the prognostic role of visible para-aortic lymph nodes (PALNs).

Methods: Patients with confirmed pathologic diagnosis of CRC were enrolled. Correlations among clinicopathologic variables were analyzed using the χ2 test. The Cox proportional hazards model was applied for univariate and multivariate analyses. Survival was estimated using the Kaplan-Meier method and log-rank test. A prognostic model for visible PALNs in CRC patients was established.

Results: In total, 4527 newly diagnosed CRC patients were enrolled. Patients with visible PALNs had inferior overall survival compared to those without visible PALNs (5-year overall survival, 67% vs. 76%, P = 0.015). Lymphovascular invasion (LVI) (hazard ratio = 1.865, P = 0.015); nodal disease (pN+) status (hazard ratio = 2.099, P = 0.006); elevated preoperative serum carcinoembryonic antigen (CEA) levels (hazard ratio = 2.263, P < 0.001); and visible PALNs ≥10 mm (hazard ratio = 1.638, P = 0.031) were independent prognostic factors for patients with visible PALNs. If each prognostic factor scored one point, 5-year overall survival of lower- (prognostic score 0-1), intermediate- (prognostic score 2), and high- (prognostic score 3-4) risk groups were, 78%. 54%, and 25% respectively (P < 0.001).

Conclusions: The prognostic model, which included LVI, pN+ status, preoperative serum CEA level, and the size of visible PALNs, could effectively distinguish the outcome of patients with visible PALNs.

No MeSH data available.


Related in: MedlinePlus