The Prognostic Significance of Extramural Deposits and Extracapsular Lymph Node Invasion in Colon Cancer
The Prognostic Significance of Extramural Deposits and Extracapsular Lymph Node Invasion in Colon Cancer
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DOI：
10.1097/dcr.0b013e31821c4944
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发表时间：
2011-08-01
影响因子：
3.9
通讯作者：
Redmond, Henry P.
中科院分区：
文献类型：
--
作者：
Al Sahaf, Osama;Myers, Eddie;Redmond, Henry P.
背景：结肠癌切除淋巴结的状态决定预后和进一步治疗。美国癌症联合委员会分期系统将壁外结节指定为非淋巴结疾病，并在第六版中将其分类为T类别的扩展，在第七版中将其分类为部位特异性肿瘤沉积物。在许多癌症中，囊外淋巴结转移是一个公认的不良预后指标。其在结肠癌中的意义尚未得到广泛研究。目的：本研究旨在确定结肠癌中壁外结节和囊外淋巴结转移的预后意义。设计：对114例III期和80例II期结肠癌进行病理回顾性分析，（使用第五，第六和第七版），以及结节和壁外沉积物的大小和轮廓。多变量考克斯回归模型被用来确定生存estimation.Results的临床病理参数的预后意义：根据第六和第七版的指南，壁外存款存在于29%和31%的患者与III期结肠癌和5%的患者与II期结肠癌。68%的病例存在囊外淋巴结浸润。多因素分析显示，淋巴结比例、淋巴结包膜外转移和辅助化疗是影响5年无病生存率的独立预后因素。除壁外沉积物外，相同的3个变量是影响总生存率的独立预后因素。壁外沉积的存在与11%的5年生存率相关，而囊外淋巴结浸润与33%的5年survival.CONCLUSIONS：而不是壁外结节被列为T类的一部分，或作为特定部位的肿瘤沉积，他们也许应该被归类为转移类别。这具有重要的预后意义，并可能扩大一些辅助剂的应用。
BACKGROUND: The status of resected lymph nodes in colon cancer determines prognosis and further treatment. The American Joint Committee on Cancer staging system has designated extramural nodules as nonnodal disease and classified them as extensions of the T category in the sixth edition and as site-specific tumor deposits in the seventh edition. Extracapsular lymph node extension is an established poor prognostic indicator in many cancers. Its significance in colon cancer has not been extensively investigated.OBJECTIVE: This study aimed to determine the prognostic significance of extramural nodules and extracapsular lymph node extension in colon cancer.DESIGN: A pathological review of 114 stage III and 80 stage II colon cancers was undertaken to analyze for p-T stage, p-N stage (using the fifth, sixth, and seventh editions), and the size and contour of nodal and extramural deposits. Multivariate Cox regression models were used to determine the prognostic significance of clinicopathological parameters on survival estimates.RESULTS: According to the sixth and seventh editions of the guidelines, extramural deposits were present in 29% and 31% of patients with stage III colon cancer and in 5% of patients with stage II colon cancer. Extracapsular lymph node invasion was present in 68% of cases. Multivariate analysis demonstrated that lymph node ratio, extracapsular lymph node extension, and adjuvant chemotherapy were independent prognostic factors affecting 5-year disease-free survival. The same 3 variables, in addition to extramural deposits, were independent prognostic factors affecting overall survival. The presence of extramural deposits was associated with an 11% 5-year survival, and extracapsular lymph node invasion was associated with a 33% 5-year survival.CONCLUSIONS: Instead of extramural nodules being included as part of the T category or as site-specific tumor deposits, they should perhaps be classified in the metastasis category. This has major prognostic implications and may broaden the application of a number of adjuvant agents.