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Synchronous Resectable Metastatic Colorectal Cancer: Lymph Node Involvement Predicts Poor Outcome.

Fu J, Jiang M, Tan Y, Yang J, Wu L, Feng L, Zheng S, Yuan Y - Medicine (Baltimore) (2015)

Bottom Line: In the COX model, the 7th AJCC TNM N-stage and LNR were independent prognostic factors.The mRNA profile was not associated with lymph node involvement.Both the N-stage according to the 7th AJCC TNM staging system and LNR had the capacity to subclassify synchronous resectable mCRC with different prognoses.The lymph node might be integrated into the AJCC staging system as a diagnose-delay prognostic factor for stage IV disease.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (JF, MJ, YT, JY, YY); Department of Oncology, Jinhua Central Hospital (Jinhua Hospital of Zhejiang University School of Medicine), Jinhua (JF); Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences) (JF, MJ, YT, JY, SZ, YY); Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang (LW); and State Key Laboratory of Molecular Oncology, Department of Aetiology and Carcinogenesis, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (LF).

ABSTRACT
To evaluate the value of lymph node status of primary tumors in predicting the prognosis of synchronous resectable metastatic colorectal cancer (mCRC).The characteristics of resectable mCRC are substantially different from other cancers, and the prognostic factors of resectable mCRC are still controversial.The data of 2007 patients with mCRC who received resection of the primary tumors and metastatic lesions synchronously were reviewed from the Surveillance, Epidemiology and End-Result database. The Kaplan-Meier method was used to evaluate the capacity of different prognostic factors. Univariate and multivariate logistic regression models were used to evaluate the relationship between the lymph node status and other factors. The mRNA profiles of primary resectable mCRC tumors were obtained by microarray at our center.The median survival times were 50, 36, 32, 27, and 19 months in the N0-stage, N1a-stage, N1b-stage, N2a-stage, and N2b-stage subgroups according to the 7th American Joint Committee on Cancer (AJCC) Tumor Lymph Node Metastasis (TNM) N-classification (P = 0.000), and 40, 29, 22, and 15 months in patients with metastatic lymph node ratio (LNR) <0.25, 0.25-0.49, 0.5-0.74, and ≥0.75 subgroups (P = 0.000). In the COX model, the 7th AJCC TNM N-stage and LNR were independent prognostic factors. The mRNA profile was not associated with lymph node involvement.Both the N-stage according to the 7th AJCC TNM staging system and LNR had the capacity to subclassify synchronous resectable mCRC with different prognoses. The lymph node might be integrated into the AJCC staging system as a diagnose-delay prognostic factor for stage IV disease.

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Related in: MedlinePlus

The overall survival in subgroup analysis with T-stage. (A) In the T1-stage subgroup, the lymph node could not predict survival, P = 0.565. (B) In the T2-stage subgroup, the lymph node could not predict survival, P = 0.517. (C) In the T3-stage subgroup, the patients with lymph node metastasis had worse survival, P = 0.000. (D) In the T4-stage subgroup, the patients with lymph node metastasis had a worse survival, P = 0.000.
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Figure 2: The overall survival in subgroup analysis with T-stage. (A) In the T1-stage subgroup, the lymph node could not predict survival, P = 0.565. (B) In the T2-stage subgroup, the lymph node could not predict survival, P = 0.517. (C) In the T3-stage subgroup, the patients with lymph node metastasis had worse survival, P = 0.000. (D) In the T4-stage subgroup, the patients with lymph node metastasis had a worse survival, P = 0.000.

Mentions: The stratified analysis with T-stage showed that lymph node metastasis could predict poor prognosis only in the T3-stage (P = 0.000) and T4-stage (P = 0.000) (Figure 2C,D), but not in T1-stage (P = 0.565) and T2-stage (P = 0.517) (Figure 2A,B). The outcomes of the stratified analyses using other factors were shown in Figure 3.


Synchronous Resectable Metastatic Colorectal Cancer: Lymph Node Involvement Predicts Poor Outcome.

Fu J, Jiang M, Tan Y, Yang J, Wu L, Feng L, Zheng S, Yuan Y - Medicine (Baltimore) (2015)

The overall survival in subgroup analysis with T-stage. (A) In the T1-stage subgroup, the lymph node could not predict survival, P = 0.565. (B) In the T2-stage subgroup, the lymph node could not predict survival, P = 0.517. (C) In the T3-stage subgroup, the patients with lymph node metastasis had worse survival, P = 0.000. (D) In the T4-stage subgroup, the patients with lymph node metastasis had a worse survival, P = 0.000.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554134&req=5

Figure 2: The overall survival in subgroup analysis with T-stage. (A) In the T1-stage subgroup, the lymph node could not predict survival, P = 0.565. (B) In the T2-stage subgroup, the lymph node could not predict survival, P = 0.517. (C) In the T3-stage subgroup, the patients with lymph node metastasis had worse survival, P = 0.000. (D) In the T4-stage subgroup, the patients with lymph node metastasis had a worse survival, P = 0.000.
Mentions: The stratified analysis with T-stage showed that lymph node metastasis could predict poor prognosis only in the T3-stage (P = 0.000) and T4-stage (P = 0.000) (Figure 2C,D), but not in T1-stage (P = 0.565) and T2-stage (P = 0.517) (Figure 2A,B). The outcomes of the stratified analyses using other factors were shown in Figure 3.

Bottom Line: In the COX model, the 7th AJCC TNM N-stage and LNR were independent prognostic factors.The mRNA profile was not associated with lymph node involvement.Both the N-stage according to the 7th AJCC TNM staging system and LNR had the capacity to subclassify synchronous resectable mCRC with different prognoses.The lymph node might be integrated into the AJCC staging system as a diagnose-delay prognostic factor for stage IV disease.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (JF, MJ, YT, JY, YY); Department of Oncology, Jinhua Central Hospital (Jinhua Hospital of Zhejiang University School of Medicine), Jinhua (JF); Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences) (JF, MJ, YT, JY, SZ, YY); Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang (LW); and State Key Laboratory of Molecular Oncology, Department of Aetiology and Carcinogenesis, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (LF).

ABSTRACT
To evaluate the value of lymph node status of primary tumors in predicting the prognosis of synchronous resectable metastatic colorectal cancer (mCRC).The characteristics of resectable mCRC are substantially different from other cancers, and the prognostic factors of resectable mCRC are still controversial.The data of 2007 patients with mCRC who received resection of the primary tumors and metastatic lesions synchronously were reviewed from the Surveillance, Epidemiology and End-Result database. The Kaplan-Meier method was used to evaluate the capacity of different prognostic factors. Univariate and multivariate logistic regression models were used to evaluate the relationship between the lymph node status and other factors. The mRNA profiles of primary resectable mCRC tumors were obtained by microarray at our center.The median survival times were 50, 36, 32, 27, and 19 months in the N0-stage, N1a-stage, N1b-stage, N2a-stage, and N2b-stage subgroups according to the 7th American Joint Committee on Cancer (AJCC) Tumor Lymph Node Metastasis (TNM) N-classification (P = 0.000), and 40, 29, 22, and 15 months in patients with metastatic lymph node ratio (LNR) <0.25, 0.25-0.49, 0.5-0.74, and ≥0.75 subgroups (P = 0.000). In the COX model, the 7th AJCC TNM N-stage and LNR were independent prognostic factors. The mRNA profile was not associated with lymph node involvement.Both the N-stage according to the 7th AJCC TNM staging system and LNR had the capacity to subclassify synchronous resectable mCRC with different prognoses. The lymph node might be integrated into the AJCC staging system as a diagnose-delay prognostic factor for stage IV disease.

Show MeSH
Related in: MedlinePlus