Novel Methods of Lymph Node Evaluation for Predicting the Prognosis of Colorectal Cancer Patients with Inadequate Lymph Node Harvest

Kwon, Taek Soo; Choi, Sung Bong; Lee, Yoon Suk; Kim, Jun Gi; Oh, Seong Taek; Lee, In Kyu

doi:10.4143/crt.2014.312

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…Preoperative detection of lymph node (LN) metastases in patients with rectal cancer is crucial for selection of the appropriate treatment strategy. LN involvement has also been shown to be a major prognostic factor in determining the risk of recurrence .…”

Section: Introductionmentioning

confidence: 99%

Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer

Dai

Zou

et al. 2018

Colorectal Disease

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Section: Introductionmentioning

confidence: 99%

Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer

Dai

Zou

et al. 2018

Colorectal Disease

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“…Therefore, determining the status of LNs is the main determinant of adjuvant chemotherapy [5,9]. Multiple large studies have shown that the LNM rate (LNR) is an important predictive factor for estimating the prognosis of CRC [2,10,11]. Therefore, adequate and accurate LN status assessment and prediction are important for treatment decision making and prognostic evaluation in CRC.…”

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confidence: 99%

A clinical-radiomics nomogram for the preoperative prediction of lymph node metastasis in colorectal cancer

Zhang

Dan

et al. 2020

J Transl Med

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Background: Accurate lymph node metastasis (LNM) prediction in colorectal cancer (CRC) patients is of great significance for treatment decision making and prognostic evaluation. We aimed to develop and validate a clinicalradiomics nomogram for the individual preoperative prediction of LNM in CRC patients. Methods:We enrolled 766 patients (458 in the training set and 308 in the validation set) with clinicopathologically confirmed CRC. We included nine significant clinical risk factors (age, sex, preoperative carbohydrate antigen 19-9 (CA19-9) level, preoperative carcinoembryonic antigen (CEA) level, tumor size, tumor location, histotype, differentiation and M stage) to build the clinical model. We used analysis of variance (ANOVA), relief and recursive feature elimination (RFE) for feature selection (including clinical risk factors and the imaging features of primary lesions and peripheral lymph nodes), established classification models with logistic regression analysis and selected the respective candidate models by fivefold cross-validation. Then, we combined the clinical risk factors, primary lesion radiomics features and peripheral lymph node radiomics features of the candidate models to establish combined predictive models. Model performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). Finally, decision curve analysis (DCA) and a nomogram were used to evaluate the clinical usefulness of the model. Results:The clinical-primary lesion radiomics-peripheral lymph node radiomics model, with the highest AUC value (0.7606), was regarded as the candidate model and had good discrimination and calibration in both the training and validation sets. DCA demonstrated that the clinical-radiomics nomogram was useful for preoperative prediction in the clinical environment.

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“…Yet, this did not increase the risk of anastomotic leakage or urinary disturbance in our patients (data not shown). IMA root dissection contributed to the average yields 26-27 lymph nodes, affording more accurate postoperative CRC staging (20).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Utility of Apical Lymph Node Metastasis in Patients With Left-sided Colorectal Cancer

Wang

Hirano

Heng

et al. 2020

In Vivo

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Background: Unlike the tumor nodes metastasis (TNM) lymph node classification, based solely on counts of nodal metastases, the Japanese system of classifying colorectal carcinoma (CRC) focuses on regional lymph node spread. In this study, we explored the prognostic utility of inferior mesenteric artery (IMA) apical lymph node (APN) metastasis. Patients and Methods: This was a retrospective study of patients with stage III left-sided CRC. All enrollees were subjected to D3 resection between April 2007 and December 2016 at the International Medical Center of Saitama Medical University and then stratified by histologic presence (APN+ group) or absence (APN− group) of tumor in APNs examined postoperatively. Ultimately, propensity score matching was invoked (1:2) and COX regression analysis was conducted, determining group rates of relapse-free survival (RFS) and cancer-specific survival (CSS). Results: A total of 498 patients were studied, grouped as APN+ (19/498, 3.8%) or APN− (479/498, 96.2%). Prior to matching, the APN+ (vs. APN−) group showed significantly more lymphatic involvement (73.7% vs. 47.8%; p=0.023), deep (T3/T4) tumor infiltration (100% vs. 78.9%; p=0.024), and nodal metastasis (N2: 84.2% vs. 27.6%; p<0.001). In addition, para-aortic nodal recurrences were significantly increased (15.7% vs. 2.0%; p<0.001), conferring worse RFS (p<0.001) and CSS (p=0.014) rates. Once baseline factors were matched, the two groups appeared similar in RFS (p=0.415) and CSS (p=0.649). Multivariate regression analysis indicated that elevated carcinoembryonic antigen (CEA) level and deep tumor infiltration were independent risk factors for RFS, whereas postoperative complications and tumor-positive node counts were independent risk factors for CSS. APN+ status was not a significant risk factor for RFS or CSS. Conclusion: APN positivity may thus constitute a regional rather than systemic manifestation. The TNM staging based on the number of metastatic lymph nodes seems to be more reasonable than the regional lymph node classification method. Patients and Methods As candidates for this retrospective analysis, a total of 2,457 patients underwent surgical resections of left-sided CRC at the International Medical Center of Saitama Medical University between April 2007 and December 2016. Exclusion criteria were as follows: 1) recurrent 2981 This article is freely accessible online.

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Novel Methods of Lymph Node Evaluation for Predicting the Prognosis of Colorectal Cancer Patients with Inadequate Lymph Node Harvest

Cited by 14 publications

References 15 publications

Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer

Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer

A clinical-radiomics nomogram for the preoperative prediction of lymph node metastasis in colorectal cancer

Prognostic Utility of Apical Lymph Node Metastasis in Patients With Left-sided Colorectal Cancer

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