Long-term Outcome After Surgical Resection of Paraaortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study.

Journal

Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764

Informations de publication

Date de publication:
16 Jul 2024
Historique:
medline: 16 7 2024
pubmed: 16 7 2024
entrez: 16 7 2024
Statut: aheadofprint

Résumé

The significance of resection of paraaortic lymph node metastasis in colorectal cancer is controversial. To clarify the prognosis of colorectal cancer after paraaortic lymph node metastasis resection. Multicenter retrospective study. Thirty-six institutions in Japan participated in this study. Patients with resected and pathologically proven paraaortic lymph node metastasis of CRC between 2010 and 2015. Database and medical records at each institution. Overall survival after paraaortic lymph node metastasis resection, recurrence-free survival, and recurrence patterns after R0 resection of paraaortic lymph node metastasis. A total of 133 patients were included in the primary analysis population in this study. The 5-year overall survival rate (95% confidence interval [CI]) was 41.0% (32.0, 49.8), and the median survival (95% CI) was 4.1 (3.4, 4.7) years. Independent prognostic factors for overall survival were the pathological T stage (pT4 vs. pT1- 3, adjusted hazard ratio [aHR]: 1.91, p = 0.006), other organ metastasis (present vs. absent, aHR: 1.98, p = 0.005), time to metastases (synchronous vs. metachronous, aHR: 2.02, p = 0.02), and number of paraaortic lymph node metastasis (≥3 vs. <3, aHR: 2.13, p = 0.001). The 5-year recurrence-free survival rate (95% CI) was 21.1% (13.5, 29.7), with a median (95% CI) of 1.2 (0.9, 1.4) years. The primary tumor location (left- vs. right-sided colon, aHR: 4.77, p = 0.01; rectum vs. right-sided colon, aHR: 5.27, p = 0.006), other organ metastasis (present vs. absent, aHR: 1.90, p = 0.03), number of paraaortic lymph node metastasis (≥3 vs. <3, aHR: 2.20, p = 0.001), and hospital volume (<10 vs. ≥10, aHR: 2.18, p = 0.02) were identified as independent prognostic factors for recurrence-free survival. Paraaortic lymph node recurrence was the most common at 33.3%. Selection bias cannot be ruled out because of the retrospective nature of the study. Less than three paraaortic lymph node metastasis was a favorable prognostic factor for both overall survival and recurrence-free survival. However, paraaortic lymph node metastases were considered to be a systemic disease and the significance of resection was limited. See Video Abstract.

Sections du résumé

BACKGROUND BACKGROUND
The significance of resection of paraaortic lymph node metastasis in colorectal cancer is controversial.
OBJECTIVE OBJECTIVE
To clarify the prognosis of colorectal cancer after paraaortic lymph node metastasis resection.
DESIGN METHODS
Multicenter retrospective study.
SETTINGS METHODS
Thirty-six institutions in Japan participated in this study.
PATIENTS METHODS
Patients with resected and pathologically proven paraaortic lymph node metastasis of CRC between 2010 and 2015.
DATA SOURCES METHODS
Database and medical records at each institution.
MAIN OUTCOME MEASURES METHODS
Overall survival after paraaortic lymph node metastasis resection, recurrence-free survival, and recurrence patterns after R0 resection of paraaortic lymph node metastasis.
RESULTS RESULTS
A total of 133 patients were included in the primary analysis population in this study. The 5-year overall survival rate (95% confidence interval [CI]) was 41.0% (32.0, 49.8), and the median survival (95% CI) was 4.1 (3.4, 4.7) years. Independent prognostic factors for overall survival were the pathological T stage (pT4 vs. pT1- 3, adjusted hazard ratio [aHR]: 1.91, p = 0.006), other organ metastasis (present vs. absent, aHR: 1.98, p = 0.005), time to metastases (synchronous vs. metachronous, aHR: 2.02, p = 0.02), and number of paraaortic lymph node metastasis (≥3 vs. <3, aHR: 2.13, p = 0.001). The 5-year recurrence-free survival rate (95% CI) was 21.1% (13.5, 29.7), with a median (95% CI) of 1.2 (0.9, 1.4) years. The primary tumor location (left- vs. right-sided colon, aHR: 4.77, p = 0.01; rectum vs. right-sided colon, aHR: 5.27, p = 0.006), other organ metastasis (present vs. absent, aHR: 1.90, p = 0.03), number of paraaortic lymph node metastasis (≥3 vs. <3, aHR: 2.20, p = 0.001), and hospital volume (<10 vs. ≥10, aHR: 2.18, p = 0.02) were identified as independent prognostic factors for recurrence-free survival. Paraaortic lymph node recurrence was the most common at 33.3%.
LIMITATIONS CONCLUSIONS
Selection bias cannot be ruled out because of the retrospective nature of the study.
CONCLUSIONS CONCLUSIONS
Less than three paraaortic lymph node metastasis was a favorable prognostic factor for both overall survival and recurrence-free survival. However, paraaortic lymph node metastases were considered to be a systemic disease and the significance of resection was limited. See Video Abstract.

Identifiants

DOI: 10.1097/DCR.0000000000003347 PMID: 39012713
pubmed: 39012713
doi: 10.1097/DCR.0000000000003347
pii: 00003453-990000000-00703
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © The ASCRS 2024.

Déclaration de conflit d'intérêts

Financial Disclosures: The authors confirm that they have no conflict of interest, funding or other sources of support to declare in connection with the submitted article.

Auteurs

Sono Ito (S)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.

Yusuke Kinugasa (Y)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.

Shinichi Yamauchi (S)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.

Hiroyuki Sato (H)

Department of Clinical Biostatistics, Tokyo Medical and Dental University, Tokyo, Japan.

Akihiro Hirakawa (A)

Department of Clinical Biostatistics, Tokyo Medical and Dental University, Tokyo, Japan.

Soichiro Ishihara (S)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.

Akio Shiomi (A)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.

Yukihide Kanemitsu (Y)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.

Takeshi Suto (T)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.

Hiroki Takahashi (H)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Michio Itabashi (M)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.

Manabu Shiozawa (M)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.

Masaya Hiyoshi (M)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastrointestinal Surgery, Ibaraki Prefectural Central Hospital, Ibaraki, Japan.

Takaya Kobatake (T)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Departments of Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan.

Koji Komori (K)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Departments of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

Hiroyuki Egi (H)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Division of Gastrointestinal Surgery and Surgical Oncology, Graduate School of Medicine, Ehime University, Ehime, Japan.

Heita Ozawa (H)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Tochigi Cancer Center, Tochigi, Japan.

Tomohiro Yamaguchi (T)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Ryo Inada (R)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.

Masaaki Ito (M)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Yasumitsu Hirano (Y)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan.

Akinobu Furutani (A)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan.

Yoshitaka Tanabe (Y)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.

Hideki Ueno (H)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, National Defense Medical College, Saitama, Japan.

Masayuki Ohue (M)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan.

Koya Hida (K)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Kazushige Kawai (K)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.

Eiji Sunami (E)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan.

Hideyuki Ishida (H)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.

Kay Uehara (K)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Jun Watanabe (J)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.

Masanori Hotchi (M)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Division of Digestive Surgery, Ehime Prefectural Central Hospital, Ehime, Japan.

Atsushi Ishibe (A)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Yasumasa Takii (Y)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.

Junichiro Hiro (J)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan.

Masakatsu Numata (M)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Yokohama City University, Yokohama, Japan.

Ichiro Takemasa (I)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.

Takeshi Kato (T)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.

Yoshihiro Kakeji (Y)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Akira Hirata (A)

Study Group for Paraaortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan.

Yoichi Ajioka (Y)

Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.

Classifications MeSH