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Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate with Survival in Stage IV Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although lymph nodes status and the ratio of metastatic to examined lymph node (LNR) are important prognostic factors in early-stage colorectal cancer (CRC), their significance in patients with metastatic disease remains unknown. The study aims to determine prognostic importance of nodal status and LNR in patients with stage IV CRC.

Methods

A cohort of 1109 eligible patients who were diagnosed with synchronous metastatic CRC in Saskatchewan during 1992–2010 and underwent primary tumor resection was evaluated. We conducted the Cox proportional multivariate analyses to determine the prognostic significance of nodal status and LNR.

Results

Median age was 70 years (22–98) and M:F was 1.2:1. Rectal cancer was found in 26 % of patients; 96 % had T3/T4 tumor, and 82 % had node positive disease. The median LNR was 0.36 (0–1.0). Fifty-four percent received chemotherapy. Median overall survival of patients who had LNR of <0.36 and received chemotherapy was 29.7 months (95 % CI 26.6–32.9) compared with 15.6 months (95 % CI 13.6–17.6) with LNR of ≥0.36 (P < .001). On multivariate analyses, no chemotherapy (HR 2.36 [2.0–2.79]), not having metastasectomy (HR 1.94 [1.63–2.32]), LNR ≥0.36 (HR 1.59 [1.38–1.84]). nodal status (HR 1.34 [1.14–1.59]), and T status (HR 1.23 [1.07–1.40]) were correlated with survival. Test for interaction was positive for LNR and high-grade cancer (HR 1.51 [1.10–2.10]).

Conclusions

Our results suggest that nodal status and LNR are important prognostic factors independent of chemotherapy and metastasectomy in stage IV CRC patients.

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Acknowledgment

We would like to thanks to Dr. Bonnie Janzen, Mrs. Carla Woites, Dr. Tong Zhu, and Saskatchewan Cancer Agency for their support for this project. The study is supported by a research grant provided by the Saskatchewan Cancer Agency, Saskatchewan, Canada.

Disclosure

No author has any competing interest to disclose.

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Authors and Affiliations

  1. Saskatchewan Cancer Agency, Saskatoon, SK, Canada

    Shahid Ahmed MD, FRCPC, FACP, Adnan Zaidi MD, Tahir Abbas MD & Duc Le MD

  2. Department of Oncology, University of Saskatchewan, Saskatoon, SK, Canada

    Shahid Ahmed MD, FRCPC, FACP, Adnan Zaidi MD, Tahir Abbas MD & Duc Le MD

  3. Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada

    Shahid Ahmed MD, FRCPC, FACP, Anne Leis PhD, Bruce Reeder MD, PhD & Punam Pahwa PhD

  4. Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada

    Selliah Chandra-Kanthan MD

  5. Department of Oncology, University of Alberta, Edmonton, AB, Canada

    Anthony Fields MD

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  1. Shahid Ahmed MD, FRCPC, FACP
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  2. Anne Leis PhD
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  3. Selliah Chandra-Kanthan MD
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  7. Duc Le MD
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  8. Bruce Reeder MD, PhD
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  9. Punam Pahwa PhD
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Corresponding author

Correspondence to Shahid Ahmed MD, FRCPC, FACP.

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Ahmed, S., Leis, A., Chandra-Kanthan, S. et al. Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate with Survival in Stage IV Colorectal Cancer. Ann Surg Oncol 23, 2287–2294 (2016). https://doi.org/10.1245/s10434-016-5200-9

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  • DOI: https://doi.org/10.1245/s10434-016-5200-9

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