Which Patients with Isolated Para-aortic Lymph Node Metastasis Will Truly Benefit from Extended Lymph Node Dissection for Colon Cancer?
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Purpose The prognosis of patients with colon cancer and para-aortic lymph node metastasis (PALNM) is poor. We analyzed the prognostic factors of extramesenteric lymphadenectomy for colon cancer patients with isolated PALNM. Materials and Methods We retrospectively reviewed 49 patients with PALNM who underwent curative resection between October 1988 and December 2009. Results In univariate analyses, the 5-year overall survival (OS) and disease-free survival (DFS) rates were higher in patients with 7 positive para-aortic lymph node (PALN) (36.5% and 27.5%) than in those with > 7 PALN (14.3% and 14.3%; p=0.010 and p=0.027, respectively), and preoperative carcinoembryonic antigen (CEA) level > 5 was also correlated with a lower 5-year OS and DFS rate of 21.5% and 11.7% compared with those with CEA 5 (46.3% and 41.4%; p=0.122 and 0.039, respectively). Multivariate analysis found that the number of positive PALN (hazard ratio [HR], 3.291; 95% confidence interval [CI], 1.309 to 8.275; p=0.011) was an independent prognostic factor for OS and the number of positive PALN (HR, 2.484; 95% CI, 0.993 to 6.211; p=0.052) and preoperative CEA level (HR, 1.953; 95% CI, 0.940 to 4.057; p=0.073) were marginally independent prognostic factors for DFS. According to our prognostic model, the 5-year OS and DFS rate increased to 59.3% and 53.3%, respectively, in patients with 7 positive PALN and CEA level 5. Conclusion PALN dissection might be beneficial in carefully selected patients with a low CEA level and less extensive PALNM.
Abstract
Purpose The prognosis of patients with colon cancer and para-aortic lymph node metastasis (PALNM) is poor. We analyzed the prognostic factors of extramesenteric lymphadenectomy for colon cancer patients with isolated PALNM. Materials and Methods We retrospectively reviewed 49 patients with PALNM who underwent curative resection between October 1988 and December 2009. Results In univariate analyses, the 5-year overall survival (OS) and disease-free survival (DFS) rates were higher in patients with 7 positive para-aortic lymph node (PALN) (36.5% and 27.5%) than in those with > 7 PALN (14.3% and 14.3%; p=0.010 and p=0.027, respectively), and preoperative carcinoembryonic antigen (CEA) level > 5 was also correlated with a lower 5-year OS and DFS rate of 21.5% and 11.7% compared with those with CEA 5 (46.3% and 41.4%; p=0.122 and 0.039, respectively). Multivariate analysis found that the number of positive PALN (hazard ratio [HR], 3.291; 95% confidence interval [CI], 1.309 to 8.275; p=0.011) was an independent prognostic factor for OS and the number of positive PALN (HR, 2.484; 95% CI, 0.993 to 6.211; p=0.052) and preoperative CEA level (HR, 1.953; 95% CI, 0.940 to 4.057; p=0.073) were marginally independent prognostic factors for DFS. According to our prognostic model, the 5-year OS and DFS rate increased to 59.3% and 53.3%, respectively, in patients with 7 positive PALN and CEA level 5. Conclusion PALN dissection might be beneficial in carefully selected patients with a low CEA level and less extensive PALNM.
참고문헌 (18)
- Choi PW, "Extensive lymphadenectomy in colorectal cancer with isolated paraaortic lymph node metastasis below the level of renal vessels", J Surg Oncol, 101, pp.66~71 (2010)[DOI]
- Gagniere J, "Retroperitoneal nodal metastases from colorectal cancer: curable metastases with radical retroperitoneal lymphadenectomy in selected patients", Eur J Surg Oncol, 41, pp.731~737 (2015)[DOI]
- Greene FL, "The American Joint Committee on Cancer: updating the strategies in cancer staging", Bull Am Coll Surg, 87, pp.13~15 (2002)
- Bae SU, "Oncologic outcomes of colon cancer patients with extraregional lymph node metastasis: comparison of isolated paraaortic lymph node metastasis with resectable liver metastasis", Ann Surg Oncol, 23, pp.1562~1568 (2016)[DOI]
- Khatri VP, "Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit?", J Clin Oncol, 23, pp.8490~8499 (2005)[DOI]
- Ogura A, "The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis", Asian J Surg, 40, pp.254~261 (2017)[DOI]
- Wiggers T, "Regression analysis of prognostic factors in colorectal cancer after curative resections", Dis Colon Rectum, 31, pp.33~41 (1988)[DOI]
- Park IJ, "Serum carcinoembryonic antigen monitoring after curative resection for colorectal cancer: clinical significance of the preoperative level", Ann Surg Oncol, 16, pp.3087~3093 (2009)[DOI]
- Thirunavukarasu P, "C-stage in colon cancer: implications of carcinoembryonic antigen biomarker in staging, prognosis, and management", J Natl Cancer Inst, 103, pp.689~697 (2011)[DOI]
- Hokuto D, "The prognosis of liver resection for patients with four or more colorectal liver metastases has not improved in the era of modern chemotherapy", J Surg Oncol, 114, pp.959~965 (2016)[DOI]
- Gonzalez M, "Risk factors for survival after lung metastasectomy in colorectal cancer patients: a systematic review and metaanalysis", Ann Surg Oncol, 20, pp.572~579 (2013)[DOI]
- Tepper JE, "Impact of number of nodes retrieved on outcome in patients with rectal cancer", J Clin Oncol, 19, pp.157~163 (2001)[DOI]
- Chang GJ, "Lymph node evaluation and survival after curative resection of colon cancer: systematic review", J Natl Cancer Inst, 99, pp.433~441 (2007)[DOI]
- Le Voyer TE, "Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089", J Clin Oncol, 21, pp.2912~2919 (2003)[DOI]
- 장기웅, "Prognostic Factors in Terms of the Number of Metastatic Nodules in Patients With Colorectal Cancer Liver Metastases", Annals of Coloproctolgy, 32(3), pp.92~100 (2016), 대한대장항문학회
- 박선진, "Clinical Significance of Lymph Node Micrometastasis in Stage I and II Colon Cancer", Cancer Research and Treatment, 40(2), pp.75~80 (2008), 대한암학회
- Nordlinger B, "Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial", Lancet Oncol, 14, pp.1208~1215 (2013)[DOI]
- Albandar MH, "Surgical management of extra-regional lymph node metastasis in colorectal cancer", Expert Rev Anticancer Ther, 16, pp.503~513 (2016)[DOI]