Clinical Significance of Extramural Tumor Deposits in the Lateral Pelvic Lymph Node Area in Low Rectal Cancer: A Retrospective Study at Two Institutions

Yagi, Ryoma; Shimada, Yasuhiro; Kameyama, Hitoshi; Tajima, Yosuke; Okamura, Takuma; Sakata, Jun; Kobayashi, Takashi; Kosugi, Shin‐ichi; Wakai, Toshifumi; Nogami, Hitoshi; Maruyama, Satoshi; Takii, Yasumasa; Kawasaki, Takashi; Honma, Keiichi

doi:10.1245/s10434-016-5379-9

Cited by 31 publications

(25 citation statements)

References 24 publications

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“…This review was conducted by a Japanese pathologist (Y.S.) with expertise on histologic features at the invasive front,(3, 23–26) for consistency with previously described diagnostic criteria. The pathologist was blinded to clinical outcomes.…”

Section: Methodsmentioning

confidence: 99%

Poorly Differentiated Clusters Predict Colon Cancer Recurrence

Konishi¹,

Shimada

Lee³

et al. 2018

American Journal of Surgical Pathology

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This study aimed to compare common histologic markers at the invasive front of colon adenocarcinoma in terms of prognostic accuracy and interobserver agreement. Consecutive patients who underwent curative resection for stages I to III colon adenocarcinoma at a single institution in 2007 to 2014 were identified. Poorly differentiated clusters (PDCs), tumor budding, perineural invasion, desmoplastic reaction, and Crohn-like lymphoid reaction at the invasive front, as well as the World Health Organization (WHO) grade of the entire tumor, were analyzed. Prognostic accuracies for recurrence-free survival (RFS) were compared, and interobserver agreement among 3 pathologists was assessed. The study cohort consisted of 851 patients. Although all the histologic markers except WHO grade were significantly associated with RFS (PDCs, tumor budding, perineural invasion, and desmoplastic reaction: P<0.001; Crohn-like lymphoid reaction: P=0.021), PDCs (grade 1 [G1]: n=581; G2: n=145; G3: n=125) showed the largest separation of 3-year RFS in the full cohort (G1: 94.1%; G3: 63.7%; hazard ratio [HR], 6.39; 95% confidence interval [CI], 4.11-9.95; P<0.001), stage II patients (G1: 94.0%; G3: 67.3%; HR, 4.15; 95% CI, 1.96-8.82; P<0.001), and stage III patients (G1: 89.0%; G3: 59.4%; HR, 4.50; 95% CI, 2.41-8.41; P<0.001). PDCs had the highest prognostic accuracy for RFS with the concordance probability estimate of 0.642, whereas WHO grade had the lowest. Interobserver agreement was the highest for PDCs, with a weighted kappa of 0.824. The risk of recurrence over time peaked earlier for worse PDCs grade. Our findings indicate that PDCs are the best invasive-front histologic marker in terms of prognostic accuracy and interobserver agreement. PDCs may replace WHO grade as a prognostic indicator.

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Section: Methodsmentioning

confidence: 99%

Poorly Differentiated Clusters Predict Colon Cancer Recurrence

Konishi¹,

Shimada

Lee³

et al. 2018

American Journal of Surgical Pathology

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“…More than 700,000 people worldwide were newly diagnosed with rectal cancer in 2018 (1). Among the metastatic pathways of rectal cancer, lymph node (LN) metastasis is the most important and closely correlated with the poor prognosis due to a high rate of local recurrence (2)(3)(4). According to the Union for International Cancer Control (UICC) TNM staging classification (8th edition) and the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines, LN status in rectal cancer is an important clinical marker in deciding TNM staging and choosing treatment options within TNM risk category of primary rectal cancer without distant metastases (5,6).…”

Section: Introductionmentioning

confidence: 99%

Radiomics Based on T2-Weighted Imaging and Apparent Diffusion Coefficient Images for Preoperative Evaluation of Lymph Node Metastasis in Rectal Cancer Patients

Yin

2021

Front. Oncol.

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PurposeTo develop and validate a radiomics nomogram based on T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) features for the preoperative prediction of lymph node (LN) metastasis in rectal cancer patients.Materials and MethodsOne hundred and sixty-two patients with rectal cancer confirmed by pathology were retrospectively analyzed, who underwent T2WI and DWI sequences. The data sets were divided into training (n = 97) and validation (n = 65) cohorts. For each case, a total of 2,752 radiomic features were extracted from T2WI, and ADC images derived from diffusion-weighted imaging. A two-sample t-test was used for prefiltering. The least absolute shrinkage selection operator method was used for feature selection. Three radiomics scores (rad-scores) (rad-score 1 for T2WI, rad-score 2 for ADC, and rad-score 3 for the combination of both) were calculated using the support vector machine classifier. Multivariable logistic regression analysis was then used to construct a radiomics nomogram combining rad-score 3 and independent risk factors. The performances of three rad-scores and the nomogram were evaluated using the area under the receiver operating characteristic curve (AUC). Decision curve analysis (DCA) was used to assess the clinical usefulness of the radiomics nomogram.ResultsThe AUCs of the rad-score 1 and rad-score 2 were 0.805, 0.749 and 0.828, 0.770 in the training and validation cohorts, respectively. The rad-score 3 achieved an AUC of 0.879 in the training cohort and an AUC of 0.822 in the validation cohort. The radiomics nomogram, incorporating the rad-score 3, age, and LN size, showed good discrimination with the AUC of 0.937 for the training cohort and 0.884 for the validation cohort. DCA confirmed that the radiomics nomogram had clinical utility.ConclusionsThe radiomics nomogram, incorporating rad-score based on features from the T2WI and ADC images, and clinical factors, has favorable predictive performance for preoperative prediction of LN metastasis in patients with rectal cancer.

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“…The lateral lymph node metastasis (LPNM) pathway of middle and low rectal cancer was rst proposed by Gerota in 1895 [1] , and the anatomical theoretical system of lateral pelvic lymphatic drainage of rectal cancer gradually formed in the 1950s [2] . LPNM has been reported in approximately 16-23% of patients with middle to low rectal cancer [3] , and it is an important predictive factor for local recurrence and long-term survival [4,5] . Lateral pelvic lymph node dissection (LPND), as a potential radical surgery, is still controversial worldwide.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Lateral Pelvic Lymph Node Dissection for Middle-Low Rectal Cancer Patients with Lateral Pelvic Lymph Node Metastasis: A Propensity Score Matching Study

Zhou

Jiang

Pei

et al. 2021

Preprint

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BackgroundThere is still controversy regarding whether the addition of lateral pelvic lymph node dissection (LPND) to total mesorectal excision (TME) confers survival benefits to rectal cancer patients with clinical lateral pelvic node metastasis (LPNM). MethodsPatients who underwent TME+LPND were systematically reviewed and divided into the LPNM group (n=29) and the non-LPNM group (n=112). The LPNM group were further subdivided into a high-risk LPNM group (n=14) and a low-risk LPNM group (n=15). Propensity score matching (PSM) was performed to minimize selection bias.ResultsOf the 141 patients undergoing LPND, the local recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM both before (27.6% vs. 4.5%, P=0.001) and after (27.6% vs 3.4%, P=0.025) PSM. Multivariate analysis revealed that LPNM was an independent risk factor for not only OS (HR: 3.06; 95% CI, 1.15–8.17; P=0.025) but also DFS (HR: 2.39; 95% CI, 1.18–4.87; P=0.016) in patients with LPNM after TME+LPND. When the LPNM group was further subdivided, multivariate logistic regression analysis showed that OS and DFS were significantly better in the low-risk group (obturator/internal iliac artery region and < 2 positive LPNs).ConclusionEven after LPND, LPNM patients have a high local recurrence rate and poor prognosis. Moreover, LPNM is an independent poor prognostic factor affecting OS and DFS after TME+LPND. However, LPND appears to confer survival benefits to specific patients with single LPN involvement in the obturator region or internal iliac vessel region.

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Clinical Significance of Extramural Tumor Deposits in the Lateral Pelvic Lymph Node Area in Low Rectal Cancer: A Retrospective Study at Two Institutions

Cited by 31 publications

References 24 publications

Poorly Differentiated Clusters Predict Colon Cancer Recurrence

Poorly Differentiated Clusters Predict Colon Cancer Recurrence

Radiomics Based on T2-Weighted Imaging and Apparent Diffusion Coefficient Images for Preoperative Evaluation of Lymph Node Metastasis in Rectal Cancer Patients

Prognostic Significance of Lateral Pelvic Lymph Node Dissection for Middle-Low Rectal Cancer Patients with Lateral Pelvic Lymph Node Metastasis: A Propensity Score Matching Study

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