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Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate with Survival in Stage IV Colorectal Cancer.
Ann Surg Oncol. 2016 07; 23(7):2287-94.AS

Abstract

BACKGROUND

Although lymph nodes status and the ratio of metastatic to examined lymph node (LNR) are important prognostic factors in early-stage colorectal cancer (CRC), their significance in patients with metastatic disease remains unknown. The study aims to determine prognostic importance of nodal status and LNR in patients with stage IV CRC.

METHODS

A cohort of 1109 eligible patients who were diagnosed with synchronous metastatic CRC in Saskatchewan during 1992-2010 and underwent primary tumor resection was evaluated. We conducted the Cox proportional multivariate analyses to determine the prognostic significance of nodal status and LNR.

RESULTS

Median age was 70 years (22-98) and M:F was 1.2:1. Rectal cancer was found in 26 % of patients; 96 % had T3/T4 tumor, and 82 % had node positive disease. The median LNR was 0.36 (0-1.0). Fifty-four percent received chemotherapy. Median overall survival of patients who had LNR of <0.36 and received chemotherapy was 29.7 months (95 % CI 26.6-32.9) compared with 15.6 months (95 % CI 13.6-17.6) with LNR of ≥0.36 (P < .001). On multivariate analyses, no chemotherapy (HR 2.36 [2.0-2.79]), not having metastasectomy (HR 1.94 [1.63-2.32]), LNR ≥0.36 (HR 1.59 [1.38-1.84]). nodal status (HR 1.34 [1.14-1.59]), and T status (HR 1.23 [1.07-1.40]) were correlated with survival. Test for interaction was positive for LNR and high-grade cancer (HR 1.51 [1.10-2.10]).

CONCLUSIONS

Our results suggest that nodal status and LNR are important prognostic factors independent of chemotherapy and metastasectomy in stage IV CRC patients.

Authors+Show Affiliations

Saskatchewan Cancer Agency, Saskatoon, SK, Canada. shahid.ahmed@saskcancer.ca. Department of Oncology, University of Saskatchewan, Saskatoon, SK, Canada. shahid.ahmed@saskcancer.ca. Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada. shahid.ahmed@saskcancer.ca.Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.Department of Oncology, University of Alberta, Edmonton, AB, Canada.Saskatchewan Cancer Agency, Saskatoon, SK, Canada. Department of Oncology, University of Saskatchewan, Saskatoon, SK, Canada.Saskatchewan Cancer Agency, Saskatoon, SK, Canada. Department of Oncology, University of Saskatchewan, Saskatoon, SK, Canada.Saskatchewan Cancer Agency, Saskatoon, SK, Canada. Department of Oncology, University of Saskatchewan, Saskatoon, SK, Canada.Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27016291

Citation

Ahmed, Shahid, et al. "Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate With Survival in Stage IV Colorectal Cancer." Annals of Surgical Oncology, vol. 23, no. 7, 2016, pp. 2287-94.
Ahmed S, Leis A, Chandra-Kanthan S, et al. Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate with Survival in Stage IV Colorectal Cancer. Ann Surg Oncol. 2016;23(7):2287-94.
Ahmed, S., Leis, A., Chandra-Kanthan, S., Fields, A., Zaidi, A., Abbas, T., Le, D., Reeder, B., & Pahwa, P. (2016). Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate with Survival in Stage IV Colorectal Cancer. Annals of Surgical Oncology, 23(7), 2287-94. https://doi.org/10.1245/s10434-016-5200-9
Ahmed S, et al. Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate With Survival in Stage IV Colorectal Cancer. Ann Surg Oncol. 2016;23(7):2287-94. PubMed PMID: 27016291.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional Lymph Nodes Status and Ratio of Metastatic to Examined Lymph Nodes Correlate with Survival in Stage IV Colorectal Cancer. AU - Ahmed,Shahid, AU - Leis,Anne, AU - Chandra-Kanthan,Selliah, AU - Fields,Anthony, AU - Zaidi,Adnan, AU - Abbas,Tahir, AU - Le,Duc, AU - Reeder,Bruce, AU - Pahwa,Punam, Y1 - 2016/03/25/ PY - 2015/11/09/received PY - 2016/3/27/entrez PY - 2016/3/27/pubmed PY - 2018/2/24/medline SP - 2287 EP - 94 JF - Annals of surgical oncology JO - Ann. Surg. Oncol. VL - 23 IS - 7 N2 - BACKGROUND: Although lymph nodes status and the ratio of metastatic to examined lymph node (LNR) are important prognostic factors in early-stage colorectal cancer (CRC), their significance in patients with metastatic disease remains unknown. The study aims to determine prognostic importance of nodal status and LNR in patients with stage IV CRC. METHODS: A cohort of 1109 eligible patients who were diagnosed with synchronous metastatic CRC in Saskatchewan during 1992-2010 and underwent primary tumor resection was evaluated. We conducted the Cox proportional multivariate analyses to determine the prognostic significance of nodal status and LNR. RESULTS: Median age was 70 years (22-98) and M:F was 1.2:1. Rectal cancer was found in 26 % of patients; 96 % had T3/T4 tumor, and 82 % had node positive disease. The median LNR was 0.36 (0-1.0). Fifty-four percent received chemotherapy. Median overall survival of patients who had LNR of <0.36 and received chemotherapy was 29.7 months (95 % CI 26.6-32.9) compared with 15.6 months (95 % CI 13.6-17.6) with LNR of ≥0.36 (P < .001). On multivariate analyses, no chemotherapy (HR 2.36 [2.0-2.79]), not having metastasectomy (HR 1.94 [1.63-2.32]), LNR ≥0.36 (HR 1.59 [1.38-1.84]). nodal status (HR 1.34 [1.14-1.59]), and T status (HR 1.23 [1.07-1.40]) were correlated with survival. Test for interaction was positive for LNR and high-grade cancer (HR 1.51 [1.10-2.10]). CONCLUSIONS: Our results suggest that nodal status and LNR are important prognostic factors independent of chemotherapy and metastasectomy in stage IV CRC patients. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/27016291/Regional_Lymph_Nodes_Status_and_Ratio_of_Metastatic_to_Examined_Lymph_Nodes_Correlate_with_Survival_in_Stage_IV_Colorectal_Cancer_ L2 - https://dx.doi.org/10.1245/s10434-016-5200-9 DB - PRIME DP - Unbound Medicine ER -