Prognostic Implications of Extranodal Extension in Relation to Colorectal Cancer Location
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Purpose Extranodal extension (ENE) is closely associated with the aggressiveness of both colon and rectal cancer. This study evaluated the clinicopathologic significance and prognostic impact of ENE in separate populations of patients with colon and rectal cancers. Materials and Methods The medical records of 2,346 patients with colorectal cancer (CRC) who underwent curative surgery at our institution between January 2003 and December 2011 were clinically and histologically reviewed. Results ENE was associated with younger age, advanced tumor stage, lymphovascular invasion (LVI), and perineural invasion (PNI) in both colon and rectal cancer. ENE rates differed significantly in patients with right colon (36.9%), left colon (42.6%), and rectal (48.7%) cancers (right vs. left, p=0.037; left vs. rectum, p=0.009). The 5-year disease-free survival (DFS) rate according to ENE status and primary tumor site differed significantly in patients with ENE-negative colon cancer (80.5%), ENE-negative rectal cancer (77.4%), ENE-positive colon cancer (68.6%), and ENE-positive rectal cancer (64.2%) (p < 0.001). Multivariate analysis showed that advanced tumor stage, ENE, LVI, PNI, and absence of adjuvant chemotherapy were independently prognostic of reduced DFS in colon and rectal cancer patients. Conclusion ENE is closely associated with the aggressiveness of colon and rectal cancers, with its frequency increasing from the right colon to the left colon to the rectum. ENE status is a significant independent predictor of DFS in CRC patients irrespective of tumor location. ENE might be more related with distally located CRC.
Abstract
Purpose Extranodal extension (ENE) is closely associated with the aggressiveness of both colon and rectal cancer. This study evaluated the clinicopathologic significance and prognostic impact of ENE in separate populations of patients with colon and rectal cancers. Materials and Methods The medical records of 2,346 patients with colorectal cancer (CRC) who underwent curative surgery at our institution between January 2003 and December 2011 were clinically and histologically reviewed. Results ENE was associated with younger age, advanced tumor stage, lymphovascular invasion (LVI), and perineural invasion (PNI) in both colon and rectal cancer. ENE rates differed significantly in patients with right colon (36.9%), left colon (42.6%), and rectal (48.7%) cancers (right vs. left, p=0.037; left vs. rectum, p=0.009). The 5-year disease-free survival (DFS) rate according to ENE status and primary tumor site differed significantly in patients with ENE-negative colon cancer (80.5%), ENE-negative rectal cancer (77.4%), ENE-positive colon cancer (68.6%), and ENE-positive rectal cancer (64.2%) (p < 0.001). Multivariate analysis showed that advanced tumor stage, ENE, LVI, PNI, and absence of adjuvant chemotherapy were independently prognostic of reduced DFS in colon and rectal cancer patients. Conclusion ENE is closely associated with the aggressiveness of colon and rectal cancers, with its frequency increasing from the right colon to the left colon to the rectum. ENE status is a significant independent predictor of DFS in CRC patients irrespective of tumor location. ENE might be more related with distally located CRC.
참고문헌 (27)
- Lee IS, "Impact of extranodal extension on prognosis in lymph nodepositive gastric cancer", Br J Surg, 101, pp.1576~1584 (2014)
- 서성환, "Prognostic Value of Extranodal Extension in Thyroid Cancer: A Meta-Analysis", Yonsei Medical Journal, 57(6), pp.1324~1328 (2016), 연세대학교의과대학[DOI]
- Fajkovic H, "Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis", Eur Urol, 64, pp.837~845 (2013)
- Nottegar A, "Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients : A systematic review and an exploratory meta-analysis", Eur J Surg Oncol, 42, pp.919~925 (2016)
- Zhang ZL, "The importance of extranodal extension in penile cancer : a metaanalysis", BMC Cancer, 15, pp.815~ (2015)
- Lee YC, "Significance of extranodal extension of regional lymph nodes in surgically resected non-small cell lung cancer", Chest, 131, pp.993~999 (2007)
- van der Velden J, "Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival", Cancer, 75, pp.2885~2890 (1995)
- Luchini C, "Significance of the prognostic stratification of extranodal extension in colorectal cancer", Ann Oncol, 27, pp.1647~ (2016)
- Edge SB, "AJCC cancer staging manual" (2017), Springer
- Yamauchi M, "Colorectal cancer: a tale of two sides or a continuum?", Gut, 61, pp.794~797 (2012)
- Tamas K, "Rectal and colon cancer : not just a different anatomic site", Cancer Treat Rev, 41, pp.671~679 (2015)
- Wei EK, "Comparison of risk factors for colon and rectal cancer", Int J Cancer, 108, pp.433~442 (2004)
- Huang Q, "Prognostic impact of extra-nodal extension on colon and rectal cancer should be investigated separately", Ann Oncol, 27, pp.956~957 (2016)
- Iacopetta B., "Are there two sides to colorectal cancer?", Int J Cancer, 101, pp.403~408 (2002)
- Kim CW, "Extranodal extension status is a powerful prognostic factor in stage III colorectal cancer", Oncotarget, 8, pp.61393~61403 (2017)
- Wang B, "Tumor location as a novel high risk parameter for stage II colorectal cancers", PLoS One, 12, pp.e0179910~ (2017)
- Luchini C, "Extranodal extension of lymph node metastasis is a marker of poor prognosis in oesophageal cancer : a systematic review with meta-analysis", J Clin Pathol, 69, pp.956~991 (2016)
- Veronese N, "Prognostic impact and implications of extracapsular lymph node involvement in colorectal cancer : a systematic review with meta-analysis", Ann Oncol, 27, pp.42~48 (2016)
- Gervaz P, "Two colons-two cancers : paradigm shift and clinical implications", J Surg Oncol, 88, pp.261~266 (2004)
- Ghazi S, "Analysis of colorectal cancer morphology in relation to sex, age, location, and family history", J Gastroenterol, 47, pp.619~634 (2012)
- Butcher D, "Female gender is a major determinant of changing subsite distribution of colorectal cancer with age", Cancer, 56, pp.714~716 (1985)
- Ogino S, "Molecular classification and correlates in colorectal cancer", J Mol Diagn, 10, pp.13~27 (2008)
- Bertario L, "Survival of patients with hereditary colorectal cancer : comparison of HNPCC and colorectal cancer in FAP patients with sporadic colorectal cancer", Int J Cancer, 80, pp.183~187 (1999)
- Markowitz SD, "Molecular origins of cancer : Molecular basis of colorectal cancer", N Engl J Med, 361, pp.2449~2460 (2009)
- Alotaibi AM, "Prognostic and oncologic significance of perineural invasion in sporadic colorectal cancer", Ann Surg Oncol, 24, pp.1626~1634 (2017)
- Lim SB, "Prognostic significance of lymphovascular invasion in sporadic colorectal cancer", Dis Colon Rectum, 53, pp.377~384 (2010)
- Andre T, "Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer", N Engl J Med, 350, pp.2343~2351 (2004)