A Distribution Weighted Prognostic Scoring Model for Node Status in Advanced Rectal Cancer
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
PurposeThere are various lymph node-based staging systems. Nevertheless, there is debateover the use of parameters such as the number of involved lymph nodes and thelymph node ratio. As a possible option, the distribution of metastatic lymph nodesmay have a prognostic significance in rectal cancer. This study is designed to evaluatethe impact of distribution-weighted nodal staging on oncologic outcome in rectalcancer. Materials and MethodsFrom a prospectively maintained colorectal cancer database of our institution, a totalof 435 patients who underwent a curative low anterior resection for mid and upperrectal cancer between 1995 and 2004 were enrolled. Patients were divided into 3groups according to the location of apical metastatic nodes. A location-weighted prognosticscore was calculated by a scoring model using a logistic regression test forlocation based-statistical weight to number of lymph nodes. All cases were categorizedin quartiles from lymph node I to lymph node IV using this protocol. ResultsThe location of lymph node metastasis was an independent factor that wasassociated with a poor prognostic outcome (p＜0.001). Based on this result, thelocation-weighted-nodal prognostic scoring model did not show lesser significantresults (p＜0.0001) in both overall survival and cancer-free survival analyses. ConclusionThe location of apical nodes among the metastatic nodes does not have a lessersignificant impact on oncologic result in patients with advanced rectal cancer. Alocation-weighted prognostic scoring model, which considered the numbers ofinvolved lymph nodes as the rate of significance according to the location, may moreprecisely predict the survival outcome in patients with lymph node metastasis.
Abstract
PurposeThere are various lymph node-based staging systems. Nevertheless, there is debateover the use of parameters such as the number of involved lymph nodes and thelymph node ratio. As a possible option, the distribution of metastatic lymph nodesmay have a prognostic significance in rectal cancer. This study is designed to evaluatethe impact of distribution-weighted nodal staging on oncologic outcome in rectalcancer. Materials and MethodsFrom a prospectively maintained colorectal cancer database of our institution, a totalof 435 patients who underwent a curative low anterior resection for mid and upperrectal cancer between 1995 and 2004 were enrolled. Patients were divided into 3groups according to the location of apical metastatic nodes. A location-weighted prognosticscore was calculated by a scoring model using a logistic regression test forlocation based-statistical weight to number of lymph nodes. All cases were categorizedin quartiles from lymph node I to lymph node IV using this protocol. ResultsThe location of lymph node metastasis was an independent factor that wasassociated with a poor prognostic outcome (p＜0.001). Based on this result, thelocation-weighted-nodal prognostic scoring model did not show lesser significantresults (p＜0.0001) in both overall survival and cancer-free survival analyses. ConclusionThe location of apical nodes among the metastatic nodes does not have a lessersignificant impact on oncologic result in patients with advanced rectal cancer. Alocation-weighted prognostic scoring model, which considered the numbers ofinvolved lymph nodes as the rate of significance according to the location, may moreprecisely predict the survival outcome in patients with lymph node metastasis.
참고문헌 (16)
- Sobin LH, "TNM classification of malignant tumours" (2009), Wiley- Blackwell
- Lee HY, "Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma", Ann Surg Oncol, 14, pp.1712~1717 (2007)
- Huh JW, "Ratio of metastatic to resected lymph nodes as a prognostic factor in node-positive colorectal cancer", Ann Surg Oncol, 17, pp.2640~2646 (2010)
- Chen SL, "Lymph node ratio as a quality and prognostic indicator in stage III colon cancer", Ann Surg, 253, pp.82~87 (2011)
- Kang J, "Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer", Ann Surg Oncol, 18, pp.704~710 (2011)
- Leibold T, "Prognostic implications of the distribution of lymph node metastases in rectal cancer after neoadjuvant chemoradiotherapy", J Clin Oncol, 26, pp.2106~2111 (2008)
- Adachi Y, "Distribution of lymph node metastasis and level of inferior mesenteric artery ligation in colorectal cancer", J Clin Gastroenterol, 26, pp.179~182 (1998)
- Alici A, "Apical lymph nodes at the root of the inferior mesenteric artery in distal colorectal cancer : an analysis of the risk of tumor involvement and the impact of high ligation on anastomotic integrity", Tech Coloproctol, 14, pp.1~8 (2010)
- Grinnell RS, "The spread of carcinoma of the colon and rectum", Cancer, 3, pp.641~652 (1950)
- Steup WH, "Patterns of lymphatic spread in rectal cancer : a topographical analysis on lymph node metastases", Eur J Cancer, 38, pp.911~918 (2002)
- Hermanek P, "Classification of colorectal carcinomas with regional lymphatic metastases", Pathol Res Pract, 173, pp.1~11 (1981)
- Hojo K, "Lymphatic spread and its prognostic value in patients with rectal cancer", Am J Surg, 144, pp.350~354 (1982)
- Japanese Society for Cancer of the Colon and Rectum, "Japanese classification of colorectal carcinoma" (1997), Kanehara & Co. Ltd.
- Kim JS, "Prognostic significance of distribution of lymph node metastasis in advanced mid or low rectal cancer", J Surg Oncol, 104, pp.486~492 (2011)
- Kanemitsu Y, "Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery", Br J Surg, 93, pp.609~615 (2006)
- Lange MM, "Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review", Dis Colon Rectum, 51, pp.1139~1145 (2008)