Prognostic and Predictive Model for Stage II Colon Cancer Patients With Nonemergent Surgery

Abstract

No ideal prognostic model has been applied to clearly identify which suitable high-risk stage II colon cancer patients with negative margins undergoing nonemergent surgery should receive adjuvant chemotherapy routinely.Clinicopathologic and prognostic data of 333 stage II colon cancer patients who underwent D2 or D3 lymphadenectomy during nonemergent surgery were retrospectively analyzed.Four pathologically determined factors, including adjacent organ involvement (RR 2.831, P = 0.001), histologic differentiation (RR 2.151, P = 0.009), lymphovascular invasion (RR 4.043, P < 0.001), and number of lymph nodes retrieved (RR 2.161, P = 0.011), were identified as independent prognostic factors on multivariate analysis. Importantly, a simple cumulative scoring system clearly categorizing prognostic risk groups was generated: risk score = ∑ coefficient’ × status (AOI + histological differentiated + lymphovascular invasion + LNs retrieved).Our new prognostic model may provide valuable information on the impact of lymphovascular invasion, as well as powerfully and reliably predicting prognosis and recurrence for this particular cohort of patients. This model may identify suitable patients with an R0 resection who should receive routine postoperative adjuvant therapy and may help clinicians to facilitate individualized treatment.In this study, we aim to provide an ideal and quantifiable method for clinical decision making in the nonemergent surgical treatment of stage II colon cancer. Our prognostic and predictive model should be applied in multicenter, prospective studies with large sample sizes, in order to obtain a more reliable clinical recommendation.

The Characteristics and Prognostic Effect of E-Cadherin Expression in Colorectal Signet Ring Cell Carcinoma

“…So, the percentage of lymphovascular invasion in SRCC is higher than conventional adenocarcinoma. Some articles have already reported that lymphovascular invasion was a prognostic variable in conventional adenocarcinoma[ 27 , 28 ]. Since lymphovascular invasion means invasion of tumor cells into lymph or blood vessels, which is important in metastatic process, and SRCC has a high rate of metastasis, we have reasons to believe that lymphovascular invasion can be a good factor for predicting prognosis in colorectal SRCC.…”

The impact of lymphovascular invasion on recurrence-free survival in high-risk stage II colorectal cancer patients treated with adjuvant therapy.

“…In some studies, different clinicopathologic features, such as T4 tumor, low count lymph node evaluation, high-grade tumor, male gender, bowel obstruction, presence of LVI or PNI, and high preoperative CEA, have been linked to a high possibility of death and recurrence (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Use of a Combination of CEA and Tumor Budding to Identify High-risk Patients with Stage II Colon Cancer

“…Recently, another study evaluated the use of multiple markers to improve the ability to identity high-risk stage II colon cancer patients (35). They used 4 pathology-determined parameters: adjacent organ involvement, histological differentiation, lymphovascular invasion and the number of lymph nodes retrieved.…”