Pathologic determinants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 patients

Abstract

Background. Patients with colorectal carcinoma found to have regional lymph node metastases after curative resection form a large and prognostically diverse group. This study aims to determine which pathology variables have independent prognostic effects. Methods. The data from the 579 patients used in this analysis were collected prospectively during a period of 21.5 years. The patients were from one institution, and the pathologic documentation was standardized. Patient follow‐up ranged between 6 months and 21.5 years. Survival analysis was by the Kaplan‐Meier method. Multivariate models were examined using Cox proportional hazards regression. Results. On univariate analysis, eight pathology variables had a significant association with survival. Six of these variables showed significant independent effects on survival on multivariate analysis. In diminishing potency, these variables were: apical lymph node involvement; spread involving a free serosal surface; invasion beyond the muscularis propria; location in the rectum; venous invasion; high tumor grade. Significant independent effects also were shown for patient age and gender. The number of involved lymph nodes added no significant independent prognostic information. Conclusion. Six pathology variables have been identified that act independently in determining the survival of patients with colorectal carcinoma and lymph node metastases. The most potent of these variables, apical lymph node involvement, was used by Dukes to subclassify Stage C tumors. Another variable, direct spread beyond the muscularis propria, defines the Astler‐Coller subclassification. It is recommended that all six independent variables be included in any future protocol for stratifying this prognostically diverse group of patients.

Hath1 Inhibits Proliferation of Colon Cancer Cells Probably Through Up-regulating Expression of Muc2 and p27 and Down-regulating Expression of Cyclin D1

“…As a cyclin dependent kinase inhibitor, p27 can arrest the cells from G1stage into S stage, so inhibit the cells proliferation (Newland et al, 1999). The levels of p27 were significantly lower than those in normal colon tissue (Loda et al, 1997).…”

Clinical presentation predicts the outcome of patients with colon cancer

“…histologic type [5,20] , perineural invasion [10][11] and radial margins are also linearly associated with outcome. Tumor DNA content, K-ras mutations, microvessel density and proliferative activity (Ki-67) are also associated with the prognosis of colon cancer.…”

“…To date, pathological staging is the single most important independent predictor of outcome [2][3][4][5][6] . Other factors such as vascular invasion [2,[7][8][9] , residual tumor [10][11][12][13] , serum carcino-embryogenic antigen levels [7,[14][15][16][17][18][19] , tumor grade [2,5,7] ,…”

Assessment of the Importance of Non-Stage Related Factors in the Prognosis of Resected Colorectal Cancer

“…Although the first serious investigation of perineural invasion in rectal cancer was reported by Seefeld in 1943 [21] the significance of PNI in CRC has been overlooked or underreported in the surgical and pathological literature until recently [7,22]. PNI does not feature in the current Royal College of Pathologists minimum dataset for colorectal cancer [23] but is included in the Royal College of Pathologists of Australasia's minimum dataset [24].…”

“…Fifty percent of Stage III cases are cured by surgery alone while up to twenty percent of stage II cases will die of colorectal cancer [7,8]. TNM Stage by itself is clearly an imprecise prognostic tool and decision making with regard to the use of adjuvant therapy may be improved by incorporation of other clinical and pathological factors of quantified importance.…”