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Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1361–1368 | Cite as

Prognostic Comparison Between Number and Distribution of Lymph Node Metastases in Patients with Right-Sided Colon Cancer

  • Chang Hyun Kim
  • Jung Wook HuhEmail author
  • Hyeong Rok Kim
  • Young Jin Kim
Colorectal Cancer

Abstract

Background

Lymph node metastasis is the most important prognostic indicator for colon cancer patients. We compared the prognostic significance of the number of lymph node metastases (LNN) and the distribution of lymph node metastases (LND).

Methods

A total of 187 patients underwent curative resection for stage III right-sided colon cancer between 2000 and 2010. We evaluated the oncologic outcomes according to LNN (N1 1–3, N2 4–6, N3 >6) and LND (LND1 metastases in pericolic nodes, LND2 metastases along the major vessels, N3 metastases around the origin of a main artery). A Cox proportional hazards model, with backward stepwise analysis was used to determine the effects of covariates on 5-year, disease-free survival (DFS) and 5-year overall survival (OS). Akaike’s information criterion (AIC), and Harrell’s concordance index (C-index) were compared for each developed model.

Results

During the median follow-up of 42.2 months, 5-year DFS and OS were 68 and 79.3 %, respectively. Multivariate analysis showed that both LNN and LND3 were independent prognostic factor for both 5-year DFS and OS. However, the prognostic model incorporating number of LNM was more precise than that of LND, with a lower AIC (5-year DFS, 554.2 vs. 566.9; 5-year OS, 318.1 vs. 337.9) and higher C-index (5-year DFS, 0.706 vs. 0.667; 5-year OS, 0.778 vs. 0.743).

Conclusions

Our results show that the staging system incorporating LNN predicted prognosis better than LND.

Keywords

Overall Survival Lymph Node Distribution Postoperative Adjuvant Chemotherapy Positive Lymph Node Metastasis Apical Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    American Joint Committee on Cancer Staging and Results Reporting. American cancer Society. Manual for staging of cancer, 1977. Chicago: American Joint Committee for Cancer Staging and End-Results Reporting; 1977.Google Scholar
  2. 2.
    Sobin LH, Fleming ID. TNM classification of malignant tumors (1997). Cancer. 1997;80(9):1803–1804.PubMedCrossRefGoogle Scholar
  3. 3.
    Greene FL, Stewart AK, Norton HJ. A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg. 2002;236:416–421.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK. Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol. 2010; 28: 264–271.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Huh JW, Kim YJ, Kim HR. Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg. 2012;255:70–78.PubMedCrossRefGoogle Scholar
  6. 6.
    Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum. 2010; 53:57–64.PubMedCrossRefGoogle Scholar
  7. 7.
    Huh JW, Kim CH, Kim HR, Kim YJ. Factors predicting oncologic outcomes in patients with fewer than 12 lymph nodes retrieved after curative resection for colon cancer. J Surg Oncol. 2012; 105:125–129.PubMedCrossRefGoogle Scholar
  8. 8.
    Huh JW, Kim YJ, Kim HR. Ratio of metastatic to resected lymph nodes as a prognostic factor in node-positive colorectal cancer. Ann Surg Oncol. 2010;17: 2640–2646.PubMedCrossRefGoogle Scholar
  9. 9.
    Yasutomi M, Baba S, Hojo K. Japanese classification of colorectal carcinoma. Tokyo: Kanehara & Co. Ltd.; 1997.Google Scholar
  10. 10.
    Park IJ, Choi GS, Kang BM, Lim KH, Jun SH. Lymph node metastasis patterns in right-sided colon cancers: is segmental resection of these tumors oncologically safe? Ann Surg Oncol. 2009;16:1501–1506.PubMedCrossRefGoogle Scholar
  11. 11.
    Kanemitsu Y, Komori K, Kimura K, Kato T. D3 lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum. 2013;56:815–824.PubMedCrossRefGoogle Scholar
  12. 12.
    Harrell FE, Jr., Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–387.PubMedCrossRefGoogle Scholar
  13. 13.
    AKAike H. Information theory and an extension of the maximum likelihood principle. Budapest, Hungary; 1973.Google Scholar
  14. 14.
    Hermanek P, Sobin L. UICC TNM classification of malignant tumors, 4th edn, 2nd revision. Springer, Berlin; 1992.Google Scholar
  15. 15.
    Dukes C, Bussey H. The spread of rectal cancer and its effect on prognosis. Br J Cancer. 1958;12:309.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Japanese Society for Cancer of Colon and Rectum. Japanese classification of colorectal carcinoma. 2nd English edn. Tokyo: Kanehara & Co. Ltd.; 2009.Google Scholar
  17. 17.
    Leibold T, Shia J, Ruo L, Minsky BD, Akhurst T, Gollub MJ, et al. Prognostic implications of the distribution of lymph node metastases in rectal cancer after neoadjuvant chemoradiotherapy. J Clin Oncol. 2008;26:2106-2111.PubMedCrossRefGoogle Scholar
  18. 18.
    Kobayashi H, Ueno H, Hashiguchi Y, Mochizuki H. Distribution of lymph node metastasis is a prognostic index in patients with stage III colon cancer. Surgery. 2006;139:516–522.PubMedCrossRefGoogle Scholar
  19. 19.
    Hida J, Okuno K, Yasutomi M, Yoshifuji T, Matsuzaki T, Uchida T, et al. Number versus distribution in classifying regional lymph node metastases from colon cancer. J Am Coll Surg. 2005;201:217–222.PubMedCrossRefGoogle Scholar
  20. 20.
    Malassagne B, Valleur P, Serra J, Sarnacki S, Galian A, Hoang C, et al. Relationship of apical lymph node involvement to survival in resected colon carcinoma. Dis Colon Rectum. 1993;36:645–653.PubMedCrossRefGoogle Scholar
  21. 21.
    Newland RC, Dent OF, Lyttle MN, Chapuis PH, Bokey EL. Pathologic determinants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 patients. Cancer. 1994;73:2076–2082.PubMedCrossRefGoogle Scholar
  22. 22.
    Vaccaro CA, Bonadeo FA, Benati ML, Quintana GMO, Fernando Rubinstein MD MPH, Mullen E, et al. Colorectal cancer staging: reappraisal of N/PN classification. Dis Colon Rectum. 2004;47:66–69.PubMedCrossRefGoogle Scholar
  23. 23.
    Kobayashi H, Enomoto M, Higuchi T, Uetake H, Iida S, Ishikawa T, et al. Clinical significance of lymph node ratio and location of nodal involvement in patients with right colon cancer. Dig Surg. 2011; 28:190–197.PubMedCrossRefGoogle Scholar
  24. 24.
    Merrie AE, Phillips LV, Yun K, McCall JL. Skip metastases in colon cancer: assessment by lymph node mapping using molecular detection. Surgery. 2001; 129: 684–691.PubMedCrossRefGoogle Scholar
  25. 25.
    Suzuki O, Sekishita Y, Shiono T, Ono K, Fujimori M, Kondo S. Number of lymph node metastases is better predictor of prognosis than level of lymph node metastasis in patients with node-positive colon cancer. J Am Coll Surg. 2006;202:732–736.PubMedCrossRefGoogle Scholar
  26. 26.
    Hogan NM, Winter DC. A nodal positivity constant: new perspectives in lymph node evaluation and colorectal cancer. World J Surg. 2013;37:878–882.PubMedCrossRefGoogle Scholar
  27. 27.
    Shatari T, Fujita M, Nozawa K, Haku K, Niimi M, Ikeda Y, et al. Vascular anatomy for right colon lymphadenectomy. Surg Radiol Anat. 2003; 25: 86–88.PubMedCrossRefGoogle Scholar
  28. 28.
    Garcia-Ruiz A, Milsom JW, Ludwig KA, Marchesa P. Right colonic arterial anatomy. Implications for laparoscopic surgery. Dis Colon Rectum. 1996;39:906–911.PubMedCrossRefGoogle Scholar
  29. 29.
    Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–596.PubMedCrossRefGoogle Scholar
  30. 30.
    Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17:1–29.PubMedCrossRefGoogle Scholar
  31. 31.
    West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012;30:1763–1769.PubMedCrossRefGoogle Scholar
  32. 32.
    West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28:272–278.PubMedCrossRefGoogle Scholar
  33. 33.
    Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Kajiwara Y, Ichikura T, et al. Prognostic significance of the number of lymph nodes examined in colon cancer surgery: clinical application beyond simple measurement. Ann Surg. 2010;251:872–881.PubMedCrossRefGoogle Scholar
  34. 34.
    Bilimoria KY, Bentrem DJ, Stewart AK, Talamonti MS, Winchester DP, Russell TR, et al. Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst. 2008;100:1310–1317.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Haboubi NY, Clark P, Kaftan SM, Schofield PF. The importance of combining xylene clearance and immunohistochemistry in the accurate staging of colorectal carcinoma. J R Soc Med. 1992;85:386–388.PubMedCentralPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Chang Hyun Kim
    • 1
  • Jung Wook Huh
    • 2
    Email author
  • Hyeong Rok Kim
    • 1
  • Young Jin Kim
    • 1
  1. 1.Department of SurgeryChonnam National University Hwasun Hospital and Medical SchoolKwangjuKorea
  2. 2.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

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