Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer
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The clinical significance of D3 lymph node dissection for patients with colon cancer remains controversial. This study aims to clarify the impact of D3 lymph node dissection on survival in patients with colon cancer.
This is a retrospective cohort study from a prospectively registered multi-institutional database of colorectal cancer in Japan. Propensity score matching method was applied to balance potential confounders of the treatment. A cohort of 10,098 patients who underwent radical colectomy for pT3 and pT4 colon cancer between 1985 and 1994 were identified. A total of 3,425 propensity score matched pairs were extracted from the entire cohort. The primary outcome measure was overall survival (OS).
In the entire cohort, there was a statistically significant difference in overall survival (OS) between the patients who had D3 and D2 lymph node dissection (p = 0.00003). The estimated hazard ratio (HR) for OS of patients who had D3 versus D2 lymph node dissection was 0.827 (95 % confidence interval, 0.757 to 0.904). In the matched cohort, there was also a significant difference in OS between the two groups (p = 0.0001), and the estimated HR for OS was 0.814 (95 % confidence interval, 0.734 to 0.904).
We found D3 lymph node dissection for pT3 and pT4 colon cancer to be associated with a significant survival advantage in a large-scale database, even after adjusting potential confounders of lymph node dissection. This finding may provide a rationale for D3 lymph node dissection in radical surgery for pT3 and pT4 colon cancer.
KeywordsColon cancer D3 lymph node dissection Overall survival Propensity score matching
This study was exempted from review by the Tochigi Cancer Center’s institutional review board, because it used pre-existing data with no personal identifiers.
Conflict of interest
- 2.Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T, Japan Cancer Surveillance Research Group (2012) Cancer incidence and incidence rates in Japan in 2006: based on data from 15 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol 42:139–147PubMedCrossRefGoogle Scholar
- 4.André T, Boni C, Navarro M, Tabernero J, Hickish T, Topham C, Bonetti A, Clingan P, Bridgewater J, Rivera F, de Gramont A (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27(19):3109–3116PubMedCrossRefGoogle Scholar
- 6.National Cancer Center, Center for Cancer Control and Information Services: the national database of hospital-based cancer registry in Japan. (in Japanese) http://ganjoho.jp/professional/statistics/hosp_c_registry.html. Accessed 20 January 2014
- 7.Gospodarowicz MK, O’Sullivan B, Sobin LH (eds) (2006) Prognostic factors in cancer, 3rd edn. John Wiley & Sons, Inc, HobokenGoogle Scholar
- 14.Japanese Society for Cancer of the Colon and Rectum (2009) Japanese classification of colorectal carcinoma. Second English ed. Kanehara-& Co., Ltd., TokyoGoogle Scholar
- 21.West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30(15):1763–1769PubMedCrossRefGoogle Scholar
- 26.Rahbari NN, Bork U, Motschall E, Thorlund K, Büchler MW, Koch M, Weitz J (2012) Molecular detection of tumor cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J Clin Oncol 30(1):60–70PubMedCrossRefGoogle Scholar