Metachronous metastasis- and survival-analysis show prognostic importance of lymphadenectomy for colon carcinomas

Abstract

BackgroundLymphadenectomy is performed to assess patient prognosis and to prevent metastasizing. Recently, it was questioned whether lymph node metastases were capable of metastasizing and therefore, if lymphadenectomy was still adequate. We evaluated whether the nodal status impacts on the occurrence of distant metastases by analyzing a highly selected cohort of colon cancer patients.Methods1,395 patients underwent surgery exclusively for colon cancer at the University of Lübeck between 01/1993 and 12/2008. The following exclusion criteria were applied: synchronous metastasis, R1-resection, prior/synchronous second carcinoma, age < 50 years, positive family history, inflammatory bowel disease, FAP, HNPCC, and follow-up < 5 years. The remaining 421 patients were divided into groups with (TM+, n = 75) or without (TM-, n = 346) the occurrence of metastasis throughout a 5-year follow-up.ResultsFive-year survival rates for TM + and TM- were 21% and 73%, respectively (p < 0.0001). Survival rates differed significantly for N0 vs. N2, grading 2 vs. 3, UICC-I vs. -II and UICC-I vs. -III (p < 0.05). Regression analysis revealed higher age upon diagnosis, increasing N- and increasing T-category to significantly impact on recurrence free survival while increasing N-and T-category were significant parameters for the risk to develop metastases within 5-years after surgery (HR 1.97 and 1.78; p < 0.0001).ConclusionsBesides a higher T-category, a positive N-stage independently implies a higher probability to develop distant metastases and correlates with poor survival. Our data thus show a prognostic relevance of lymphadenectomy which should therefore be retained until conclusive studies suggest the unimportance of lmyphadenectomy.

The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer

“…Colorectal cancer is a leading cause of cancer death. Nodal disease is associated with a worse overall prognosis and adjuvant chemotherapy is usually used in this setting . Nodal status is classified as N0, N1 or N2 under the AJCC TNM system (7th edition), based on the number of positive nodes (N0, no positive nodes; N1, one to three positive nodes; N2, four or more positive nodes) .…”

Evaluation of relapse-free survival in T3N0 colon cancer: The role of chemotherapy—A multicentric retrospective analysis.

“…The most important American and European guidelines demand at least 12 lymph nodes to be sampled and examined to accurately determine the stage of colon cancer [1,6,16]. The relationship between lymph node retrieved and survival is however not completely understood because no proof that distant metastases can derive from lymph node metastases has so far yielded [37]. In a recent prospective study Santos and coll.…”

A novel cycloartane triterpenoid from Cimicifuga induces apoptotic and autophagic cell death in human colon cancer HT-29 cells

“…Alarmingly, increasing numbers of reported cases of colon cancer in recent years has made this form of cancer a major health concern (4). The prognosis for CRC remains poor, as few exclusively effective agents have been developed for the treatment of CRC (5). The most effective treatment for CRC is surgery, yet, even after curative resection, the recurrence rate is high.…”