Influence of extent of lymph node dissection on survival for patients with pT2 colon cancer
- 348 Downloads
The optimal extent of lymph node dissection for early-stage colon cancer (CC) remains undefined. This study assessed the influence of the extent of lymph node dissection on overall survival (OS) in patients with pT2 CC.
We retrospectively examined data from the multi-institutional registry system of the Japanese Society for Cancer of the Colon and Rectum and used a propensity score matching method to balance potential confounders of lymph node dissection. We extracted 463 matched pairs from 1433 patients who underwent major resections for pT2 CC between 1995 and 2004.
Lymph node metastasis was found in 301 (21.0 %) of 1433 patients with pT2 CC. In this cohort, significant independent risk factors for lymph node metastasis were lymphatic invasion and venous invasion. Patients who underwent D3 or D2 lymph node dissection did not significantly differ in OS, either among the propensity score-matched cohort (estimated hazard ratio [HR] 0.85, 95 % confidence interval [CI] 0.536–1.346, P = 0.484) or in the cohort as a whole (HR 0.720, 95 % CI 0.492–1.052, P = 0.089).
For patients with pT2 CC, D3 lymph node dissection did not add to OS. D2 lymph node dissection may be adequate for pT2 CC.
KeywordspT2 colon cancer Lymph node metastasis Lymph node dissection Overall survival Propensity score matching
This study was considered exempt by the Tochigi Cancer Center’s institutional review board because it used preexisting data without 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(2):139–147. doi: 10.1093/jjco/hyr184, Epub 2011 Dec 15CrossRefPubMedGoogle Scholar
- 3.Kotake K, Honjo S, Sugihara K, Kato T, Kodaira S, Takahashi T, Yasutomi M, Muto T, Koyama Y (2003) Changes in colorectal cancer during a 20-year period: an extended report from the multi-institutional registry of large bowel cancer. Japan Dis Colon Rectum 46(10 Suppl):S32–S43Google Scholar
- 4.Bhangu A, Brown G, Nicholls RJ, Wong J, Darzi A, Tekkis P (2013) Survival outcome of local excision versus radical resection of colon or rectal carcinoma: a Surveillance, Epidemiology, and End Results (SEER) population-based study. Ann Surg 258(4):563–569. doi: 10.1097/SLA.0b013e3182a4e85a, discussion 569–71PubMedGoogle Scholar
- 6.National Comprehensive Cancer Network (2015) Clinical practice guidelines in oncology. Colon cancer version 2. NCCN.org. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf (Accessed December, 2014)
- 7.Watanabe T, Itabashi M, Shimada Y, Japanese Society for Cancer of the Colon and Rectum et al (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17(1):1–29. doi: 10.1007/s10147-011-0315-2 CrossRefPubMedGoogle Scholar
- 11.Japanese Society for Cancer of the Colon and Rectum (1997) Japanese Classification of Colorectal Carcinoma. 1st English edition. Kanehara & Co., Ltd, TokyoGoogle Scholar
- 12.Hida J, Okuno K, Yasutomi M, Yoshifuji T, Uchida T, Tokoro T, Shiozaki H (2005) Optimal ligation level of the primary feeding artery and bowel resection margin in colon cancer surgery: the influence of the site of the primary feeding artery. Dis Colon Rectum 48(12):2232–2237CrossRefPubMedGoogle Scholar
- 20.Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, Brown G, Tudyka V, D’Hoore A, Kennedy RH, West NP, Kim SH, Heald R, Storli KE, Nesbakken A, Moran B (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Colorectal Dis 29(4):419–428. doi: 10.1007/s00384-013-1818-2 CrossRefPubMedGoogle Scholar
- 21.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):3109–3116. doi: 10.1200/JCO.2008.20.6771 CrossRefPubMedGoogle Scholar
- 23.Kotake K, Honjo S, Sugihara K, Hashiguchi Y, Kato T, Kodaira S, Muto T, Koyama Y (2012) Number of lymph nodes retrieved is an important determinant of survival of patients with stage II and stage III colorectal cancer. Jpn J Clin Oncol 42(1):29–35. doi: 10.1093/jjco/hyr164 CrossRefPubMedGoogle Scholar
- 28.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):60–70. doi: 10.1200/JCO.2011.36.9504 CrossRefPubMedGoogle Scholar
- 30.Lips DJ, Koebrugge B, Liefers GJ, van de Linden JC, Smit VT, Pruijt HF, Putter H, van de Velde CJ, Bosscha K (2011) The influence of micrometastases on prognosis and survival in stage I-II colon cancer patients: the Enroute⊕ study. BMC Surg 11:11. doi: 10.1186/1471-2482-11-11 CrossRefPubMedCentralPubMedGoogle Scholar