Prognostic impact and implications of extracapsular lymph node involvement in colorectal cancer: a systematic review with meta-analysis

Abstract

The extranodal extension (ENE) of nodal metastasis (i.e. the extension of tumor cells through the nodal capsule into the perinodal adipose tissue) has recently emerged as an important prognostic factor in different types of malignancies. However, the tumor-node-metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a systematic review and meta-analysis to determine the prognostic role of ENE in patients with lymph node-positive colorectal cancer.Materials and methods: Two independent authors searched PubMed and SCOPUS until 7 January 2015 without language restrictions. Prospective studies reporting data on prognostic parameters in subjects with colorectal cancer, comparing participants with the presence of ENE (ENE+) versus only intranodal extension (ENE−) were eligible. Data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) together with 95% confidence intervals (CIs) for time-dependent risk related to ENE+, adjusted for potential confounders.Results: Thirteen studies including 1336 patients were identified with a median follow-up of 4.7 years. ENE was associated with a higher T stage and tumor grading. In addition, ENE was associated with a significantly increased risk of allcause mortality (

Colorectal cancer and the KIR genes in the human genome: A meta-analysis

“…Most colorectal cancers originate from the benign adenomas that forms in colon. Molecular and genetic studies indicate that about 70% of colorectal cancers arise by mutation and inactivation of the gene adenomatous polyposis coli ( APC ) and other tumors arising as a result of activating mutations in the genes that producing beta-catenin and axin [16], [20], [21], [22]. Also other genetic studies have shown that this cancer usually arises due to the mutations that cause instability of some chromosomes and change the structure of these chromosomes.…”

Extranodal extension of lymph node metastasis is a marker of poor prognosis in oesophageal cancer: a systematic review with meta-analysis

“…Neoplastic emboli, free tumour cells deposits in soft tissue and metastasis in the marginal sinus and should not be considered as true ENE. Notably, the presence of tumour cells in the adipose tissue is recognised as associated to a poor prognosis: for example, in the TNM staging system for colorectal cancer, the free tumour deposits in the adipose tissue are recognised as important prognostic parameters, constituting a specific subcategory in N group, named N1c 6 8. Furthermore, ENE has also been taken into account in the last staging systems of squamous cell carcinoma of the vulva, playing an important and adverse prognostic role 10.…”

Analysis of histological and immunological parameters of metastatic lymph nodes from colon cancer patients reveals that T-helper 1 type immune response is associated with improved overall survival

“…The ability of tumor cells to invade the capsular tissue and degrade extracellular matrix is assumed to be a dismal sign. [5,6] However, the prognostic significance of ECI is not consistent across all studies. [7] In addition, it was shown that activation of follicles in metastatic LN is associated with improved prognosis, [8] maybe because it serves a surrogate for a protective immune response.…”