Omission of Adjuvant Chemotherapy Is Associated With Increased Mortality in Patients With T3N0 Colon Cancer With Inadequate Lymph Node Harvest

Wells, Katerina; Hawkins, Alexander T.; Krishnamurthy, Devi M.; Dharmarajan, Sekhar; Glasgow, Sean C.; Hunt, Steven R.; Mutch, Matthew G.; Wise, Paul E.; Silviera, Matthew L.

doi:10.1097/dcr.0000000000000729

Cited by 42 publications

(27 citation statements)

References 19 publications

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“…The issue may be more than just an academic one, given that lymph node-negative pT3 tumors belong to a higher overall prognostic stage group compared with pT2 cases (IIA versus I) and may additionally benefit from adjuvant chemotherapy, particularly if they also fulfill certain high-risk criteria. [14][15][16][17][18][19] Therefore, we aimed to compare the clinicopathologic features and prognostic outcomes of this group of inconsistently staged tumors that seemingly exist as a histologic intermediary between the pT2 and pT3 categories. Our goal was to further define this diagnostically challenging subset of tumors and investigate whether their clinicopathologic characteristics and predictive behavior are more akin to pT2 or pT3 lesions, in order to further inform current staging guidelines as to their proper classification.…”

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confidence: 99%

Pathology and Prognosis of Colonic Adenocarcinomas With Intermediate Primary Tumor Stage Between pT2 and pT3

Paulsen

Polydorides

2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Primary tumor stage (pT) is an important prognostic indicator in colonic adenocarcinomas; however, cases that have no muscle fibers beyond the advancing tumor edge but also show no extension beyond the apparent outer border of muscularis propria (termed pT2int), have not been previously studied. Objective.— To address the clinicopathologic characteristics and prognosis of pT2int tumors. Design.— We recharacterized 168 colon carcinomas and compared pT2int cases to bona fide pT2 and pT3 tumors. Results.— In side-by-side analysis, 21 pT2int cases diverged from 29 pT2 tumors only in terms of larger size (P = .03), but they were less likely to show high-grade (P = .03), lymphovascular (P < .001), and extramural venous invasion (P = .04); discontinuous tumor deposits (P = .02); lymph node involvement (P = .001); and advanced stage (P = .001), compared with 118 pT3 tumors. Combining pT2int with pT2 cases (versus pT3) was a better independent predictor of negative lymph nodes in multivariate analysis (P = .04; odds ratio [OR], 3.96; CI, 1.09–14.42) and absent distant metastasis in univariate analysis (P = .04), compared with sorting pT2int with pT3 cases (versus pT2). Proportional hazards regression showed that pT2 and pT2int cases together were associated with better disease-free survival compared with pT3 tumors (P = .04; OR, 3.65; CI, 1.05–12.70). Kaplan-Meier analysis demonstrated that when pT2int were grouped with pT2 tumors, they were significantly less likely to show disease progression compared with pT3 (P = .002; log-rank test) and showed a trend toward better disease-specific survival (P = .06), during a mean patient follow-up of 44.9 months. Conclusions.— These data support the conclusion that pT2int carcinomas have clinicopathologic characteristics and are associated with patient outcomes more closely aligned with pT2 rather than pT3 tumors.

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confidence: 99%

Pathology and Prognosis of Colonic Adenocarcinomas With Intermediate Primary Tumor Stage Between pT2 and pT3

Paulsen

Polydorides

2021

Archives of Pathology &Amp; Laboratory Medicine

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“…Furthermore, AC is recommended in colon cancers of Stage II and higher with inadequate lymphadenectomy [3]. Wells et al [35] previously described low adherence to this recommendation, with AC use of only 36%. Our work supports this previously described disparity and highlights lymph node yield as an important pathological quality measure.…”

Section: Discussionmentioning

confidence: 99%

N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database

et al. 2020

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Aim: Colorectal cancer staging has evolved to define N1c as the presence of tumour deposits without concurrent positive lymph nodes. Work to date reports poor prognosis in N1c colon cancer, with Stage III categorization and adjuvant chemotherapy (AC) recommended. No study has yet evaluated the prevalence, treatment compliance or treatmentrelated outcomes on a national scale. We aimed to evaluate the prevalence of N1c colon cancer, use, outcomes and factors associated with AC in the USA. Method: The National Cancer Database was reviewed for N1cM0 colon adenocarcinomas that underwent resection from 2010 to 2016. Cases were stratified into 'AC' or 'no AC' cohorts. The Kaplan-Meier method was used to estimate overall survival (OS) and compare the AC and no AC cohorts using the log-rank test. Multivariable logistic regression identified factors associated with AC. The main outcome measures were the prevalence and factors associated with AC use and its impact in N1c disease. Results: Of the 5684 (1.59% of 357 752) colon adenocarcinomas that were N1c, 55% (n = 3071) received AC. AC significantly improved 1-, 3-and 5-year OS compared with no AC (96.2%, 80%, 67.4% and 72.9%, 48.5%, 33.8%, respectively; P < 0.001). Compared with the no AC group, AC patients were younger, had less comorbidity, were of the male gender and received minimally invasive surgery at an academic treatment centre (all P < 0.05). Socioeconomic and procedural factors significantly impacted the use of AC. Conclusion: In the USA, AC is underutilized in N1c colon cancer despite significantly improved OS. Socioeconomic and procedural factors associated with AC were identified, highlighting disparities in AC use and opportunities to improve oncological outcomes and survival.

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“…14 Omission of a single metastatic lymph node and leaving it with the patient can cause understaging and deprive patients of required adjuvant treatment which may increase survival. 15 Additionally, it has been shown that harvested lymph node numbers can be a denominator for recurrence and survival in patients with locally advanced (T3-T4) node-negative rectal cancer. 16 Although the American Joint Committee on Cancer and International Union Against Cancer recommended retrieval of at least 12 lymph nodes for staging of rectal cancer, 17 there are some studies that suggest to identify all the lymph nodes in each specimen and not to stop at 12.…”

Section: Discussionmentioning

confidence: 99%

En-Bloc Excision of the High-ligated Inferior Mesenteric Vein Pedicle With the Specimen in Patients Undergoing Minimally Invasive and Open Sphincter Saving Rectal Resections for Cancer

Bilgin¹,

Aytaç²,

Baca³

et al. 2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Although high-ligated pedicle of the inferior mesenteric artery is usually kept in the resected specimens, the value of preserving high-ligated pedicle of the inferior mesenteric vein within the resected specimens of the sphincter saving rectal resections for cancer is not well defined. In the current study, patients undergoing open, laparoscopic, and robotic sphincter saving rectal resection for cancer were prospectively included. Lymph node invasion and presence of lymph nodes along the IMV pedicles were analyzed. In total 100 patients were included. There were lymph nodes in 63 patients at the IMV and 71 patients at the IMA pedicles. En-bloc removal of the high-ligated IMV pedicle with the resected specimen significantly increased the number of harvested lymph nodes (P < 0.001) regardless of surgical modality (P = 0.36). Although it increases the number of harvested lymph nodes with acceptable operative morbidity, no oncological benefits were found related to preservation of high-ligated pedicle of the inferior mesenteric vein within the resected specimen of the rectum.

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Omission of Adjuvant Chemotherapy Is Associated With Increased Mortality in Patients With T3N0 Colon Cancer With Inadequate Lymph Node Harvest

Abstract: Patients with T3N0 colon cancer with inadequate lymph node harvest who receive adjuvant chemotherapy have increased overall survival. Despite this survival benefit, a fraction of these patients receive adjuvant chemotherapy. Barriers to chemotherapy are multifactorial.

Cited by 42 publications

References 19 publications

Pathology and Prognosis of Colonic Adenocarcinomas With Intermediate Primary Tumor Stage Between pT2 and pT3

Pathology and Prognosis of Colonic Adenocarcinomas With Intermediate Primary Tumor Stage Between pT2 and pT3

N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database

En-Bloc Excision of the High-ligated Inferior Mesenteric Vein Pedicle With the Specimen in Patients Undergoing Minimally Invasive and Open Sphincter Saving Rectal Resections for Cancer

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