Skip to main content
SpringerLink
Log in

Survival in Resected Stage II Colorectal Cancer Is Dependent on Tumor Depth, Vascular Invasion, Postoperative CEA Level, and The Number of Examined Lymph Nodes

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of the present study was to determine which aspects of tumor histology influence postoperative early relapse and overall survival rates after radical resection of stage II colorectal cancer (CRC).

Methods

Data were collected for 425 patients with stage II CRC who began treatment at a single institution between January 2006 and October 2013. All the enrolled patients were followed up on until death or until December 2014. Clinically significant factors affecting postoperative early relapse and overall survival rates were analyzed.

Results

Using a multivariate analysis, tumor invasion depth (P = 0.008), vascular invasion (P = 0.029), postoperative carcinoembryonic antigen (CEA) level (P = 0.001), and retrieval of less than 12 lymph nodes (P = 0.002) were found to be independent predictors for postoperative early relapse. A combination of tumor invasion depth, vascular invasion, postoperative CEA level, and number of lymph nodes retrieved showed that the greater the number of predictors involved, the higher the likelihood of postoperative early relapse and the poorer the overall survival.

Conclusions

This study revealed that T4 invasion, vascular invasion, postoperative CEA level, and the number of examined lymph nodes may significantly affect the prognosis of stage II CRC patients after radical resection. The risks of postoperative early relapse and worse clinical outcome increase in proportion to the values of these four parameters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cancer registry annual report, Taiwan, R.O.C., 2011. Taipei: Ministry of Health and Welfare, the Executive Yuan, R.O.C., 2011. http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx?No=201404160001

  2. Shepherd NA, Baxter KJ, Love SB (1997) The prognostic importance of peritoneal involvement in colonic cancer: a prospective evaluation. Gastroenterology 112:1096–1102

    Article  CAS  PubMed  Google Scholar 

  3. Ambiru S, Miyazaki M, Ito H et al (1998) Resection of hepatic and pulmonary metastases in patients with colorectal carcinoma. Cancer 82:274–278

    Article  CAS  PubMed  Google Scholar 

  4. Michael JO, Megan EC, Richard MG et al (2008) Survival following recurrence in stage II and III colon cancer: findings from the ACCENT data set. J Clin Oncol 26:2336–2341

    Article  Google Scholar 

  5. Hwang CC, Chai HT, Chen HW et al (2011) S100B protein expressions as an independent predictor of early relapse in UICC stage II and III colon cancer patients after curative resection. Ann Surg Oncol 18:139–145

    Article  PubMed  Google Scholar 

  6. Tsai HL, Yang IP, Lin CH et al (2013) Predictive value of vascular endothelial growth factor overexpression in early relapse of colorectal cancer patients after curative resection. Int J Colorectal Dis 28:415–424

    Article  PubMed  Google Scholar 

  7. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM Classification of malignant tumors, 7th edn. Wiley, New York, pp 100–105

    Google Scholar 

  8. Hamilton SR, Vogelstein B, Kudo S et al (2000) Carcinoma of the colon and rectum. In: Hamilton SR, Aaltonen LA (eds) World health organization classification of tumors, pathology and genetics. Tumors of the Digestive System, Lyon, pp 105–119

    Google Scholar 

  9. Tsai HL, Chu KS, Huang YH et al (2009) Predictive factors of early relapse in UICC stage I–III colorectal cancer patients after curative resection. J Surg Oncol 100:736–743

    Article  PubMed  Google Scholar 

  10. Tsai HL, Yang IP, Huang CW et al (2013) Clinical significance of microRNA-148a in patients with early relapse of stage II and III colorectal cancer after curative resection. Transl Res 162:258–268

    Article  CAS  PubMed  Google Scholar 

  11. Lipska L, Visokai V, Levy M et al (2007) Tumor markers in patients with relapse of colorectal carcinoma. Anticancer Res 27:1901–1906

    CAS  PubMed  Google Scholar 

  12. Klaus D, William S, Frank O et al (2012) Absence of extramural venous invasion is an excellent predictor of metastasis-free survival in colorectal carcinoma stage II- a study using tangential tissue sectioning. J Clin Pathol 65:619–623

    Article  Google Scholar 

  13. Morris M, Platell C, deBoer B et al (2006) Population-based study of prognostic factors in stage II colonic cancer. Br J Surg 93:866–871

    Article  CAS  PubMed  Google Scholar 

  14. Petersen VC, Baxter KJ, Love SB et al (2002) Identification of objective pathological prognostic determinants and models of prognosis in Dukes’ B colon cancer. Gut 51:65–69

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Desolneux G, Burtin P, Lermite E et al (2010) Prognostic factors in node-negative colorectal cancer: a retrospective study from a prospective database. Int J Colorectal Dis 25:829–834

    Article  PubMed  Google Scholar 

  16. Quirke P, Morris E (2007) Reporting colorectal cancer. Histopathology 50:103–112

    Article  CAS  PubMed  Google Scholar 

  17. Khankhanian N, Mavligit GM, Russell WO et al (1977) Prognostic significance of vascular invasion in colorectal cancer of Dukes’ B class. Cancer 39:1195–1200

    Article  CAS  PubMed  Google Scholar 

  18. Ishizuka D, Shirai Y, Sakai Y et al (2001) Colorectal carcinoma liver metastases: clinical significance of preoperative measurement of serum carcinoembryonic antigen and carbohydrate antigen 19-9 level. Int J Colorectal Dis 16:32–37

    Article  CAS  PubMed  Google Scholar 

  19. Holubee L Jr, Topolcan O, Pikner R et al (2003) Criteria for the selection of referential groups in tumor marker statistical evaluation on the basis of a retrospective study. Anticancer Res 23:856–870

    Google Scholar 

  20. Chapman MA, Buckley D, Henson DB et al (1998) Preoperative carcinoembryonic antigen is related to tumor stage and long-term survival in colorectal cancer. Br J Cancer 78:1346–1349

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Lin JK, Lin CC, Yang SH et al (2011) Early postoperative CEA level is a better prognostic indicator than is preoperative CEA level in predicting prognosis of patients with curable colorectal cancer. Int J Colorectal Dis 26:1135–1141

    Article  PubMed  Google Scholar 

  22. Park YA, Lee KY, Kim NK et al (2006) Prognostic effect of perioperative change of serum carcinoembryonic antigen level: a useful tool for detection of systemic recurrence in rectal cancer. Ann Surg Oncol 13:645–650

    Article  PubMed  Google Scholar 

  23. Wang JY, Lu CY, Chu KS et al (2007) Prognostic significance of pre- and postoperative serum carcinoembryonic antigen levels in patients with colorectal cancer. Eur Surg Res 39:245–250

    Article  CAS  PubMed  Google Scholar 

  24. Hotta T, Takifuji K, Uchiyama K et al (2006) Potential predictors of survival after surgery for colorectal cancer patients with synchronous unresectable liver metastases. Oncol Rep 16:1369–1374

    PubMed  Google Scholar 

  25. Yakabe T, Nakafusa Y, Sumi K et al (2010) Clinical significance of CEA and CA 19-9 in postoperative follow-up of colorectal cancer. Ann Surg Oncol 17:2349–2356

    Article  PubMed  Google Scholar 

  26. McCall JL, Black RB, Rich CA et al (1994) The value of serum carcinoembryonic antigen in predicting recurrence disease following curative resection of colorectal cancer. Dis Colon Rectum 37:875–881

    Article  CAS  PubMed  Google Scholar 

  27. Wang JY, Lu CY, Chu KS et al (2007) Prognostic significance of per- and post-operative serum carcinoembryonic antigen levels in patients with colorectal cancer. Eur Surg Res 39:245–250

    Article  CAS  PubMed  Google Scholar 

  28. Tsai HL, Cheng KI, Lu CY et al (2008) Prognostic significance of depth of invasion, vascular invasion and numbers of lymph node retrievals in combination for patients with stage II colorectal cancer undergoing radical resection. J Surg Oncol 97:383–387

    Article  PubMed  Google Scholar 

  29. Bilimoria KY, Stewart AK, Palis BE et al (2008) Adequacy and importance of lymph node evaluation for colon cancer in the elderly. J Am Coll Surg 206:247–254

    Article  PubMed  Google Scholar 

  30. Vather R, Sammour T, Kahokehr A et al (2009) Lymph node evaluation and long-term survival in stage II and stage III colon cancer: a national study. Ann Surg Oncol 16:585–593

    Article  PubMed  Google Scholar 

  31. Green FL, Page DL, Fleming ID et al (2001) AJCC cancer staging handbook, 6th edn. Springer, New York

    Google Scholar 

Download references

Acknowledgements

This work was supported by Grants from the Excellence for Cancer Research Center (MOST104-2325-B-037-001); the Ministry of Health and Welfare (MOHW 104-TDU-B-212-124-003), Taiwan, Republic of China; Kaohsiung Medical University Hospital (KMUH100-OM16, KMUH103-3R16, KMUHS10304, KMUHS10305); the Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University (KMU-TP103C00, KMU-TP103C03, KMU-TP103C07, KMU-TP103H11, KMU-TP104A11); and the Grant of Biosignature in Colorectal Cancers, Academia Sinica, Taiwan.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang-Lin Tsai, Ching-Wen Huang, Yung-Sung Yeh, Cheng-Jen Ma & Jaw-Yuan Wang

  2. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang-Lin Tsai, Ching-Wen Huang & Jaw-Yuan Wang

  3. Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang-Lin Tsai, Chao-Wen Chen & Jaw-Yuan Wang

  4. Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Wen Huang, Yung-Sung Yeh, Cheng-Jen Ma & Jaw-Yuan Wang

  5. Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chao-Wen Chen

  6. Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Cheng-Jen Ma & Jaw-Yuan Wang

  7. Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, and Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 807, Kaohsiung, Taiwan

    Jaw-Yuan Wang

Authors
  1. Hsiang-Lin Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ching-Wen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chao-Wen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yung-Sung Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cheng-Jen Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jaw-Yuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaw-Yuan Wang.

Ethics declarations

Conflict of interest

The authors state no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsai, HL., Huang, CW., Chen, CW. et al. Survival in Resected Stage II Colorectal Cancer Is Dependent on Tumor Depth, Vascular Invasion, Postoperative CEA Level, and The Number of Examined Lymph Nodes. World J Surg 40, 1002–1009 (2016). https://doi.org/10.1007/s00268-015-3331-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-3331-y

Keywords

Search

Navigation