A Modified Tumor‐Node‐Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined

Zhang, Hao; Liu, Yunxiao; Wang, Chunlin; Guan, Zilong; Yu, Hang; Xu, Chao; Zheng, Mingyu; Wang, Yuliuming; Hu, Hanqing; Huang, Rui; Wang, Guiyu

doi:10.1007/s00268-021-06141-0

Cited by 4 publications

(7 citation statements)

References 26 publications

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“…TA B L E 2 Correlation of CDC42 expression with demographics and comorbidities in CRC patients chemotherapy 23 ; thus, CDC42 was correlated with adjuvant chemotherapy administration.…”

Section: Discussionmentioning

confidence: 99%

“…The present study discovered that blood CDC42 was linked to higher T stage, N stage, TNM stage, abnormal CEA, and adjuvant therapy administration among CRC patients. The potential explanation might be that: (1) CDC42 could suppress CD8 + T cells activation and promote the immune escape, consequently inducing the tumor growth and invasion, which resulted in higher T, N, and TNM stages 10,13,22 ; (2) CDC42 might be able to directly accelerate tumor growth and invasion through several pathways, such as vascular endothelial growth factor and membrane‐anchored neuropilin‐1 signalings, which could lead to elevated T, N, and TNM stages 14–16 ; (3) CDC42 could accelerate tumor growth and invasion, as well as correlate with higher T, N, and TNM stage (above‐mentioned), which led to the increment of tumor marker (CEA); (4) CDC42 was related to higher TNM stage (above‐mentioned); meanwhile, TNM stage could critically affect whether patients would receive adjuvant chemotherapy 23 ; thus, CDC42 was correlated with adjuvant chemotherapy administration.…”

Section: Discussionmentioning

confidence: 99%

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The relation of blood cell division control protein 42 level with disease risk, comorbidity, tumor features/markers, and prognosis in colorectal cancer patients

Gao

Xue

et al. 2022

Clinical Laboratory Analysis

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Background: Cell division control protein 42 (CDC42) is involved in colorectal cancer (CRC) progression by modulating CD8 + T cell activation, immune escape, and direct oncogenetic biological processes. This study aimed to explore the correlation of blood CDC42 with disease risk, comorbidities, disease features, tumor markers, and prognosis among CRC patients.Methods: CDC42 in peripheral blood mononuclear cells was detected by reverse transcription-quantitative polymerase chain reaction from 250 resectable CRC patients and 50 healthy controls (HCs). CDC42 was divided by quartiles, as well as high and low expressions in CRC patients for correlation and survival analysis.Results: CDC42 was elevated in CRC patients vs. HCs (p < 0.001), which had a good ability to distinguish CRC patients from HCs with the area under the curve (95% confidence interval) of 0.889 (0.841-0.937). In CRC patients, CDC42 was not associated with demographics or comorbidities (all p > 0.05), while its higher quartile was linked to increased T stage (p < 0.001), N stage (p = 0.009), TNM stage (p < 0.001), abnormal carcinoembryonic antigen (p = 0.043), and adjuvant chemotherapy administration (p = 0.002). Higher CDC42 quartile (p = 0.002) and CDC42 high (vs. low) (p < 0.001) were related to worse disease-free survival (DFS); meanwhile, elevated CDC42 quartile (p = 0.002) and CDC42 high (vs. low) (p = 0.001) were also linked to poor overall survival (OS). Multivariate Cox's regression analysis presented that CDC42 quartile 3 and 4 (vs. quartile 1) independently predicted declined DFS and OS (all p < 0.05). Conclusion:Circulating CDC42 relates to higher disease risk, T, N, and TNM stage, abnormal tumor marker, and poor prognosis among CRC patients.

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“…TA B L E 2 Correlation of CDC42 expression with demographics and comorbidities in CRC patients chemotherapy 23 ; thus, CDC42 was correlated with adjuvant chemotherapy administration.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The relation of blood cell division control protein 42 level with disease risk, comorbidity, tumor features/markers, and prognosis in colorectal cancer patients

Gao

Xue

et al. 2022

Clinical Laboratory Analysis

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“…In recent years, clinical schedules for colon cancer become standardized and streamlined. Lymph node count, as a crucial postoperative pathological data, plays an important role in the accurate estimation of patient prognosis and rational formulation of therapeutic scheme [ 3 – 5 ]. Based on the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) guidelines, a minimum of 12 lymph node counts is essential to ensure proper lymphadenectomy and accurate tumor stage [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The optimal minimum lymph node count for carcinoembryonic antigen elevated colon cancer: a population-based study in the SEER set and External set

et al. 2023

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Purpose The aim of this paper was to clarify the optimal minimum number of lymph node for CEA-elevated (≥ 5 ng/ml) colon cancer patients. Methods Thirteen thousand two hundred thirty-nine patients from the SEER database and 238 patients from the Second Affiliated Hospital of Harbin Medical University (External set) were identified. For cancer-specific survival (CSS), Kaplan-Meier curves were drawn and data were analyzed using log-rank test. Using X-tile software, the optimal cut-off lymph node count was calculated by the maximal Chi-square value method. Cox regression model was applied to perform survival analysis. Results In CEA-elevated colon cancer, 18 nodes were defined as the optimal minimum node. The number of lymph node examined (< 12, 12-17 and ≥ 18) was an independent prognosticator in both SEER set (HR12-17 nodes = 1.329, P < 0.001; HR< 12 nodes = 1.985, P < 0.001) and External set (HR12-17 nodes = 1.774, P < 0.032; HR< 12 nodes = 2.741, P < 0.006). Moreover, the revised 18-node standard could identify more positive lymph nodes compared with the 12-node standard in this population. Conclusions With the purpose of favorable long-term survival and accurate nodal stage for CEA-elevated colon cancer patients, the 18-node standard could be regarded as an alternative to the 12-node standard advocated by the ASCO and NCCN guidelines.

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“…1,2 Lymph node (LN) status is among the strongest prognostic factors in patients with CRC, and it is the key selection criterion for adjuvant chemotherapy. 3 LN dissection plays an important role in surgery of CRC for achieving long-term survival. Procuring a minimum of 12 nodes is recommended by several international guidelines.…”

Section: Introductionmentioning

confidence: 99%

“…Procuring a minimum of 12 nodes is recommended by several international guidelines. 3 Since Cabanas showed the existence of a so-called sentinel LN, this concept has been used effectively to detect LN metastasis (LNM). 4 The concept of sentinel LN mapping in CRC is not new, although it has not had the same impact as in breast cancer and melanoma.…”

Section: Introductionmentioning

confidence: 99%

Mesenteric location of lymph node metastasis for colorectal cancer

Sasaki

Shigeta

Matsui

et al. 2023

ANZ Journal of Surgery

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Background: The number of lymph node metastasis (LNM) is a strong prognostic factor in the treatment of colorectal cancer (CRC). However, the impact of the mesentery location on LNM remains unclear. We assessed the impact LNM location on the recurrence of stage III CRC. Methods: Subjects with CRC and pathologically positive LNM were enrolled retrospectively. We defined three groups: LNM adjacent to the tumour (group A), metastases with horizontal or vertical spread (group B), and metastases with both horizontal and vertical spread (group C). Recurrence-free survival (RFS) was the primary outcome measure used for the study. Results: A total of 241 (Group A: 121, B: 90, and C: 30) patients were recruited for the study. Multivariate analysis by Cox regression model indicated LNM location to be an independent predisposing risk factor for recurrence [group B: Hazard ratio (HR) 2.01, 95% Confidential interval (CI) 1.12-3.60, P = 0.019; group C: HR 3.00, 95% CI 1.34-6.72, P = 0.008]. Addition of mesentery spread to the N classification was significant risk factor for recurrence (mN2a: HR 2.01, 95% CI 1.07-3.78, P = 0.029; mN2b: HR 3.96, 95% CI 2.12-7.40, P < 0.01). Comparison of Harrell's C-index values was conducted, and the modified N staging risk was 0.6377, whereas the TNM N stage classification was 0.5869. Conclusion: Mesentery location of LNM was a risk factor and consideration of it might be beneficial for accurate prediction of CRC prognosis.

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A Modified Tumor‐Node‐Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined

Cited by 4 publications

References 26 publications

The relation of blood cell division control protein 42 level with disease risk, comorbidity, tumor features/markers, and prognosis in colorectal cancer patients

The relation of blood cell division control protein 42 level with disease risk, comorbidity, tumor features/markers, and prognosis in colorectal cancer patients

The optimal minimum lymph node count for carcinoembryonic antigen elevated colon cancer: a population-based study in the SEER set and External set

Mesenteric location of lymph node metastasis for colorectal cancer

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