Prognostic value of radiologically enlarged lymph nodes in node‐negative colon cancer

Song, Weimin; Zheng, Zheyu; Hu, Jiancong; Chen, Yongle; Deng, Weihao; He, Xiaowen; Lan, Ping

doi:10.1111/codi.14938

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…Patients with enlarged rLN had poor DFS and OS because of micrometastasis of these LNs. 21 Bruno and his colleagues demonstrated that node‐negative colon cancer with more than seven enlarged LN (>5 mm) had a significantly better outcome comparing those without. 22 These contrasting results showed that the prognostic value of LN in colorectal cancer remained unclear and additional studies with a larger sample size were necessary.…”

Section: Discussionmentioning

confidence: 99%

“…One study of our center had reported that the enlarged rLN was a risk factor in colon cancer. Patients with enlarged rLN had poor DFS and OS because of micrometastasis of these LNs 21 . Bruno and his colleagues demonstrated that node‐negative colon cancer with more than seven enlarged LN (>5 mm) had a significantly better outcome comparing those without 22 .…”

Section: Discussionmentioning

confidence: 99%

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Radiological lymph‐node size improves the prognostic value of systemic inflammation index in rectal cancer with pathologically negative nodes

Peng

Liu

et al. 2023

Cancer Medicine

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Background The relationship between the radiological lymph node (rLN) size and survival outcome in node‐negative rectal cancer is still uncertain. In this study, we aimed to explore the role of enlarged rLN in predicting the survival of node‐negative rectal cancers. Methods We retrospectively reviewed the records of 722 node‐negative rectal cancer who underwent curative resection. Factors associated with DFS (disease‐free survival) and CSS (cancer‐specific survival) were assessed with univariate and multivariate analysis. Survival analysis was performed according to presence with or without enlarged rLN. Combining rLN with NLR as a new index‐inflammation immune score (IIS) for predicting survival. Comparing different models to assess the predictive powers. Results A total of 119 patients had tumor recurrence and 73 patients died due to cancer. Patients with enlarged rLN (≥5 mm) was significantly associated with better DFS (HR:0.517, 95%CI:0.339–0.787, p = 0.002) and CSS (HR:0.43, 95%CI:0.242–0.763, p = 0.004). The risk factors of recurrence were rLN, neutrophil‐lymphocyte ratio (NLR), CEA level, and distance from the anal verge. The risk of recurrence increased by 1.88‐ and 2.83‐fold for the high score in IIS compared with the low and intermediate score group (All p < 0.001). Similarly, the high score in IIS also increased the risk of cancer‐specific death. In the model comparison, the AIC and LR were improved by including the rLN into the NLR model for DFS and CSS prediction (All p < 0.05). Conclusions Node‐negative rectal cancer patients with enlarged rLN had a better survival outcome. IIS might be a more comprehensive and complete inflammation immune index for survival prediction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiological lymph‐node size improves the prognostic value of systemic inflammation index in rectal cancer with pathologically negative nodes

Peng

Liu

et al. 2023

Cancer Medicine

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“…Murphy et al 15 and Okada et al 16 reported that among patients with colon cancer pathologically diagnosed as negative for LN metastasis (pathological N0, pN0), those with enlarged LNs had a better prognosis than those without enlarged LNs. However, Song et al 18 reported that enlarged LNs were correlated with a poor prognosis, even in patients with pN0 colon cancer. Therefore, the immunological effect for better prognosis in stage II CRC patients with enlarged LNs remains unelucidated.…”

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confidence: 99%

Prognostic Significance of Enlarged Lymph Nodes in Stage II Colorectal Cancer

Matsunaga¹,

Sasaki²,

Nozawa³

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Many studies have reported a correlation between lymph node metastasis and prognosis in patients with colorectal cancer. However, the clinical significance of enlarged lymph nodes for prognosis has scarcely been explored. OBJECTIVE: We aimed to assess the clinical significance of enlarged lymph node in stage II colorectal cancer. DESIGN: This is a multicenter retrospective observational study with a median follow-up period of 66.8 months. SETTINGS: Patients’ medical records were retrospectively collected from the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer database. PATIENTS: We included 2212 patients with stage II colorectal cancer who underwent surgical resection between January 2009 and December 2012. Patients were classified into the enlarged lymph node and non-enlarged lymph node groups and their data were compared. MAIN OUTCOME MEASURES: Clinicopathological characteristics and prognoses of the two groups were compared. The main outcomes measured were recurrence-free survival and overall survival. RESULTS: The enlarged lymph node group showed significantly better overall survival and recurrence-free survival in pT4b cases, but not in pT3 nor pT4a cases. In pT4b cases, enlarged lymph node (HR, 0.53; 95% CI, 0.29–0.98) was an independent prognostic factor for longer recurrence-free survival, whereas rectal lesion (HR, 3.46; 95% CI, 1.90–6.29) was an independent prognostic factor for shorter RFS. Enlarged lymph node was associated with a lower distant recurrence rate (HR, 0.49; 95% CI, 0.26–0.92) and tendency to correlate with better overall survival (HR, 0.50; 95% CI, 0.22–1.14). LIMITATIONS: The retrospective design may have increased the risk of selection bias. Inadequate information regarding enlarged lymph node is another study limitation. CONCLUSIONS: This study showed that enlarged lymph nodes are associated with a favorable prognosis in patients with pT4b stage II colorectal cancer.

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“…Previous studies have also shown lymph node follicular hyperplasia in the drainage areas of patients with stage II colon cancer [9], suggesting an association between non-metastatic enlargement of tumordraining lymph nodes and the tumor-adaptive immune response. Recently, some studies have reported that BLNE is a favourable prognostic factor for colorectal cancer [7,10], while other studies have proposed hat it is associated with poorer prognosis [11]. Therefore, the clinical signi cance of mesenteric BLNE in stage I/II CRC with remains unclear.…”

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confidence: 99%

Mesenteric benign lymph node enlargement in colorectal cancer: Friend or Foe?

Wang,

Shi,

Guo

et al. 2024

Preprint

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Background: Benign lymph node enlargement (BLNE) is common in colorectal cancer; however, few studies have investigatedits influence on prognosis, clinicopathological features, and pathogenesis. Methods: Patients who underwent radical surgery for colorectal cancer at Peking University Third Hospital were grouped according to the presence ofBLNE, and their prognosis and clinical characteristics were analysed. The immune microenvironment and genomic characteristics of primary tumors were comprehensively explored in representative patients. Results: Overall,630 AJCC stage I/IIpatients, with 131 in the BLNE group and 499 in the Non-BLNE (NBLNE) group, were included in the study. Patients in the BLNE group exhibited better disease-free survival (DFS) (hazard ratio [HR] 0.44, P = 0.016) and overall survival (OS) (HR 0.46, P = 0.011) . Interestingly, the prognosis of patients without lymph node metastasis wasworse when the number of harvested lymph nodes was more than 15. On computed tomography (CT) images, significant differences in lymph node morphology were found between BLNE and metastatic lymph node enlargement, including lymph node border, shape and enhancement characteristics. Pathologically, compared with the NBLNE group, the BLNE group had more mature tertiary lymphoid structures (66.7% vs. 36.5%, P = 0.002), greater immunoscore (18.8% vs. 2.1%, P = 0.004) in tumor tissue, and more abundant lymph follicles in lymph nodes (13.69 ± 4.89 vs. 5.08 ± 3.87, P < 0.0001). Whole-exon sequencing analysis revealed greater TMB in the BLNE group [ 6.03 (5.59, 7.59) vs. 5.33 (4.62, 6.34), P = 0.025). 11 differentially mutated genes were identified between the BLNE groupand NBLNE group, with MUC12 (81%) as the most common mutated gene in the BLNE group (odds ratio [OR] 0.10, P = 0.0002). Conclusion: BLNE is a positive factor in predicting the prognosis of colorectal cancer, possibly becausepatients with BLNE have a stronger anti-tumorimmune response. Accurate preoperative lymph node staging is critical.

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Prognostic value of radiologically enlarged lymph nodes in node‐negative colon cancer

Cited by 6 publications

References 20 publications

Radiological lymph‐node size improves the prognostic value of systemic inflammation index in rectal cancer with pathologically negative nodes

Radiological lymph‐node size improves the prognostic value of systemic inflammation index in rectal cancer with pathologically negative nodes

Prognostic Significance of Enlarged Lymph Nodes in Stage II Colorectal Cancer

Mesenteric benign lymph node enlargement in colorectal cancer: Friend or Foe?

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