Optimizing nodal and staging classification in low rectal cancers with lateral node metastasis: multicentre retrospective cohort study.
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
08 03 2022
08 03 2022
Historique:
received:
02
05
2021
revised:
13
01
2022
accepted:
14
01
2022
entrez:
8
3
2022
pubmed:
9
3
2022
medline:
10
5
2022
Statut:
ppublish
Résumé
Patients with lateral node metastasis in low rectal cancers have a poor prognosis. However, variability in patient survival in terms of lateral metastatic status has not been thoroughly investigated. This study was conducted to assess the prognostic value of lateral node involvement and to review nodal classification. Patients with stage III low rectal cancers who underwent lateral node dissection were retrospectively reviewed. Two cohorts were set: the first one (1995-2006) was selected using a Japanese multi-institutional database and was used for development of a new nodal system, and the second (2007-2013) was collected from referral institutions for validation of findings. Variables correlated with poor prognosis were investigated. Next, a modified classification of lateral-positive nodal cancers was created. Finally, this new classification was compared with TNM and Japanese classification-based systems according to the Akaike information criterion (AIC) and concordance index (c-index). Overall, 742 and 508 patients were selected for cohorts 1 and 2, respectively. Based on the analyses on cohort 1, patients with two or more lateral metastatic nodes partially spreading into regions outside of internal iliac area exhibited poor prognosis; accordingly, a modified N classification was created, where TNM-N1 and N2a cancers with this feature were upgraded, respectively, to N2a and N2b. The modified N classification yielded the most favourable indices (AIC = 2661.08; c-index = 0.6477) compared with the TNM (AIC = 2662.36; c-index = 0.6457) and Japanese classification-based systems (AIC = 2684.06; c-index = 0.6302). All findings were confirmed by analysing cohort 2. A modified nodal system is proposed to account for the significance of lateral node metastasis.
Sections du résumé
BACKGROUND
Patients with lateral node metastasis in low rectal cancers have a poor prognosis. However, variability in patient survival in terms of lateral metastatic status has not been thoroughly investigated. This study was conducted to assess the prognostic value of lateral node involvement and to review nodal classification.
METHODS
Patients with stage III low rectal cancers who underwent lateral node dissection were retrospectively reviewed. Two cohorts were set: the first one (1995-2006) was selected using a Japanese multi-institutional database and was used for development of a new nodal system, and the second (2007-2013) was collected from referral institutions for validation of findings. Variables correlated with poor prognosis were investigated. Next, a modified classification of lateral-positive nodal cancers was created. Finally, this new classification was compared with TNM and Japanese classification-based systems according to the Akaike information criterion (AIC) and concordance index (c-index).
RESULTS
Overall, 742 and 508 patients were selected for cohorts 1 and 2, respectively. Based on the analyses on cohort 1, patients with two or more lateral metastatic nodes partially spreading into regions outside of internal iliac area exhibited poor prognosis; accordingly, a modified N classification was created, where TNM-N1 and N2a cancers with this feature were upgraded, respectively, to N2a and N2b. The modified N classification yielded the most favourable indices (AIC = 2661.08; c-index = 0.6477) compared with the TNM (AIC = 2662.36; c-index = 0.6457) and Japanese classification-based systems (AIC = 2684.06; c-index = 0.6302). All findings were confirmed by analysing cohort 2.
CONCLUSION
A modified nodal system is proposed to account for the significance of lateral node metastasis.
Identifiants
pubmed: 35257141
pii: 6544103
doi: 10.1093/bjsopen/zrac006
pmc: PMC8902341
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.
Références
Ann Surg. 2012 Jun;255(6):1129-34
pubmed: 22549752
Int J Clin Oncol. 2020 Jan;25(1):1-42
pubmed: 31203527
Stat Med. 1996 Feb 28;15(4):361-87
pubmed: 8668867
Lancet Oncol. 2012 Jun;13(6):616-21
pubmed: 22591948
Surgery. 2017 Aug;162(2):303-314
pubmed: 28366499
J Anus Rectum Colon. 2019 Oct 30;3(4):175-195
pubmed: 31768468
Dis Colon Rectum. 2006 Nov;49(11):1663-72
pubmed: 17041749