Prognosis of node-positive colon cancer

Abstract

The most recent American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging system subgroups patients into one to three and four or more positive nodes. However, the Gastrointestinal Study Group and the National Surgical Adjuvant Breast and Bowel Project divides node-positive patients into one to four and five or greater. A Cox multi-variate retrospective analysis was done of the overall survival of node-positive colon cancer patients with the specific objective of determining the most appropriate subcategorization. Data on 306 patients with node-positive colon cancer who underwent potentially curative surgery from 1970 to 1984 were analyzed retrospectively. No patient received adjuvant chemotherapy. Also excluded were patients with synchronous resected metastatic disease or those with rectal primaries. The median follow-up was 6 years, and the median survival for the entire group was 8.6 years. By univariate analysis, the following were significant prognostic features: number of positive nodes (P less than 0.0001), degree of differentiation (P less than 0.0001), colon primary site (P = 0.009), tumor stage (P = 0.001), and tumor size (P less than 0.0001). Lymphatic/blood vessel invasion and a mucinous histology were not significant. By Cox multivariate analysis the number of positive lymph nodes remained the best discriminant of survival (P = 0.0001). The number of positive nodes was related inversely to prognosis with the optimal dichotomization between one to three (66% 5-year survival) and four or greater nodes (37% 5-year survival).

The Prognostic Significance of Number of Lymph Node Metastasis in Colon Cancer – Based on Japanese Techniques of Resection and Handling of Resected Specimens

“…Depth of invasion and number of regional lymph node metastasis(LNM) are known to be important prognostic factors for colorectal cancer, and these factors are used to determine the stage of the disease (Chapuis et al,1985;Vaccaro et al, 2004;Choen et al, 1991). In Japan, on the basis of clinical studies on colorectal cancer the general rules for clinical and pathological studies of cancer of the colon, rectum and anus which has been modified continuously (JGR, 1977).…”

Tumour markers of prognosis in colorectal cancer

“…As Dukes' staging is widespread and common practice, there would be no logic in finding a marker that simply gave the same information (Astler and Coller, 1954;Cohen et al, 1991). Rather, proteins (or other variables) which demonstrate a strong correlation with Dukes' stage (or other staging systems) should be considered as possible novel targets for anti-cancer therapies.…”

“…However, the simplest and most widely applied prognostic feature is the presence of lymph node metastasis in a surgical resection specimen. This forms the basis of all staging systems for this disease and has repeatedly been shown to have more prognostic power than any other single feature at presentation (Astler and Coller, 1954;Cohen et al, 1991).…”

Regression of colon cancer and induction of antitumor immunity by intratumoral injection of adenovirus expressing interleukin-12

“…1 Surgery is associated with a 90% 5-year survival rate in patients with tumors involving only the mucosa or submucosa. However, in those patients with transmural penetration, survival decreases to 60 -80%; 2 only ϳ30 -60% of patients with regional lymph node metastasis 3 and Ͻ6% of those with distant metastasis are disease free at 5 years. 4 At present there is no therapeutic regime capable of prolonging survival in patients with advanced colon cancer.…”