Clinical Research
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Associated Factors of The Metastatic Lymph Node Involvement in Colorectal Cancers

Year 2022, Volume: 2 Issue: 3, 7 - 14, 15.12.2022
https://doi.org/10.29228/HMJ.22

Abstract

INTRODUCTION: The number of Metastatic Lymph Nodes [MLN] is the most important prognostic factor that affects disease-free and overall survival in many cancer types. In the study, the factors associated with metastatic lymph node involvement were investigated in Colorectal Cancers [CRC].
METHODS: A total of 192 colorectal cancer patients who underwent curative surgery between 2016 and 2021 were included in the study. Patients who had a diagnosis other than adenocarcinoma, whose data could not be obtained and emergency cases were excluded from the study. According to these 4 groups, patients were compared in terms of parameters such as age, gender, T stage, tumor stage, histopathological grade, tumor localization, Lymphovascular Invasion [LVI], Perineural Invasion [PNI], NLR [Neutrophil/Lymphocyte Ratio], LMO [Lymphocyte/Monocyte Ratio], monocyte count, and the total number of lymph nodes.
RESULTS: Among the 192 patients included in the study, 75 (39.06%) were female, and 117 [60.94%] were male. The mean age was 67 [23: 89], and the mean follow-up time was 20 [2: 63] months. According to metastatic lymph node involvement, the number of N0, N1, N2a, and N2b patients was 101, 57, 20, 14, respectively. No significant relations were detected between metastatic lymph node involvement and age, gender, NLR, and LMO. As the number of metastatic lymph nodes increased, survival rates decreased [p=0.002]. Histopathological grade, t stage, LVI, PNI, increased tumor diameter, the total number of lymph nodes removed, and increased monocytes were found to be significantly associated with metastatic lymph node involvement
DISCUSSION AND CONCLUSION: n the present study, except for standard prognostic factors, increased monocytes were associated with lymph node enlargement. In the case of high monocyte counts in patients who are scheduled for minimally invasive surgery or in Stage Ⅱ, we suggest that caution should be exercised, and the treatment plan should be made accordingly.

References

  • 1. Corman ML. Carcinoma of the Colon. In: Corman ML (Ed.) Colon & Rectal Surgery. 5th Ed. 767-903, Lippincot Williams & Wilkins, Philadelphia, 2005
  • 2. U.S. Cancer Statistics Working Group. United States cancer statistics: 2002 Incidence and mortality web-based report version. Centers for Disease Control and Prevention, and National Cancer Institute, 2005. Available at http://www. cdc.gov/cancer/npcr/uscs, http://seer.cancer.gov/statistics, accessed January 18, 2006
  • 3. Fry RD, Mahmoud N, Maron DJ, Ross HM. Colon and Rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL (Eds.) Sabiston Textbook of Surgery. 18th Ed. 1348-1432, Saunders Elsevier, Philadelphia, 2008
  • 4. TÜİK.Ölüm nedeni istatistikleri, 2017. tuikweb.tuik.gov.tr/PreHaberBultenleri.do.id=27592
  • 5. Hari DM, Leung AM, Lee JH, et al. AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg 2013;217:181–90.
  • 6. Benson AB, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004; 22: 3408-19.
  • 7. Hermanek P. Prognostic factor research in oncology. J Clin Epidemiol 1999; 52:371-374
  • 8. Sarli L, Bader G, Lusco D, et al. Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 2005;41:272-279
  • 9. Johnson PM, Poster GA, Ricciordi R and Baxter NN. Increasing negative lymph node count is independently associated with improved long term survival in stage IIIB and IIIC colon cancer. J Clin Oncol 2006;24:3570-3575
  • 10. Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD. The ASCRS Textbook of Colon and Rectal Surgery. Bleday R, Garcia-Aguilar J, Surgical Treatment of Rectal Cancer. Springer, New York, 2007; 413-436
  • 11. Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinoma arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985;89: 328-36.
  • 12. Haggitt RC. Management of the patients with Carcinomas in an adenoma. Prog Clin Biol Res 1988;279: 89-99.
  • 13.Wang HS, Liang WY, Lin TC, et al. Curative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis. Dis Colon Rectum 2005;48: 1182–1192.
  • 14. Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003;10(1):65-71.
  • 15. Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, et al. Prognostic evalution of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of secondary analysis of a large scale adjuvant trial. Ann Surg 2002;235(/4):458-63
  • 16. Hermanek P, Gospodarowicz MK, Henson DE, et al. International Union Against Cancer (IUCC): Prognostic factors in cancer. Berlin. Springer New York, 1995.
  • 17. Wolmark N, Wieand HS, Rockette HE, et al. The prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Findings from the NSABP clinical trials. Ann Surg 1983;198:743-752.
  • 18. Xu FY, Di MJ, Dong JK, et al. Influence of clinical and pathomorphological parameters on prognosis in colon carcinoma and rectal carcinoma. Zhejiang Da Xue Xue Bao Yi Xue Ban 2006;35: 303–310
  • 19. Park YJ, Park KJ, Park JG, et al. Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg 1999;23: 721-726.
  • 20. Minsky BD, Miles C, Rich TA, et al. Lymphatic vessel invasion as an independent prognostic factors for survival in colorectal cancer. Int Radiat Oncol Biol Phys 1989;17: 311-18.
  • 21. Weiser MR, Landmann RG, Kattan MW, et al. Individualized prediction of colon cancer recurrence using nomogram. J Clin Oncol 2008;26:380-85.
  • 22. Sökmen S. Kolorektal Kanserde Prognoz, Kolorektal Özel Sayısı. Türkiye Klinikleri Journal of Surgery 2004;9: 57-65.
  • 23. Benek S, Tatar C, Kocakusak A, Ozer B, Kizilkaya MC, Aydin H. The effect of demographic, biochemical and patholojical parameters on survival in colorectal cancer. J Turgut Ozal Med Cent 2016;23(4):414-9.
  • 24. Minsky BD, Mies C, Rich TA, Recht A. Lymphatic vessel invasion is an independent prognostic factor for survival in colorectal cancer. International Journal of Radiation Oncology* Biology* Physics. 1989; 17(2): 311-8
  • 25. Saclarides TJ, Bhattacharyya AK, Britton-Kuzel C, Szeluga D, Economou SG. Predicting lymph node metastases in rectal cancer. Dis Colon Rectum 1994; 37: 2-57.
  • 26. Shirouzu K, Isomoto H, Kakegawa T. Prognostic evaluation of perineurotic invasion in rectal cancer. AM J Surg. 1993;165:233-37
  • 27. Fujita S, Shimoda T, Yoshimura K, et al. Prospective evaluation of prognostic factors in patients with colorectal cancer undergoing curative resection. J Surg Oncol 2003; 84: 127-31
  • 28. Batsakis J. Nerves and neurotropic carcinomas. The Annals of otology, rhinology, and laryngology. 1985; 94(4 Pt 1):426.
  • 29. Luo XL, He W, Huang H, et al. Design of a prognostic score model for nasopharyngeal carcinoma. Head Neck. In press. Head & Neck 2015; 37: 624-629
  • 30. Tsai YD, Wang CP, Chen CY, et al. Pretreatment circulating monocyte count associated with poor prognosis in patients with oral cavity cancer. Head Neck 2014; 36: 947– 953.

Kolorektal Kanserlerde Metastatik Lenf Nodu Tutulumu ile İlişkili Faktörler

Year 2022, Volume: 2 Issue: 3, 7 - 14, 15.12.2022
https://doi.org/10.29228/HMJ.22

Abstract

GİRİŞ ve AMAÇ: Metastatik lenf nodu (MLN) sayısı birçok kanserde hastalıksız ve genel sağkalımı etkileyen en önemli prognostik faktördür. Bu çalışmada kolorektal kanserlerde (KRK) metastatik lenf nodu tutulumu ile ilişkili faktörleri ideledik.
YÖNTEM ve GEREÇLER: Çalışmaya 2016-2021 yılları arasında küratif cerrahi uygulanan 192 kolorektal kanser hastası dahil edildi. Adenokanser dışı başka tanısı olan, verilerine ulaşılmayan hastalar ve acil vakalar çalışma dışı bırakıldı. Hastalar lenf nodu tutulumuna göre 4 gruba ayrıldı. Bu 4 gruba göre hastalar yaş, cinsiyet, T stage, tümör evresi, histopatolojik grade, tümör lokalizasyonu, lenfovasküler invazyon(LVİ), perinöral invazyon (PNİ), NLO (Nötrofil/lenfosit oranı), LMO (Lenfosit/monosit oranı), monosit sayısı, total lenf nodu sayısı gibi parametreler açısından karşılaştırıldı.
BULGULAR: Çalışmaya dahil edilen 192 hastanın 75’i (%39.06) kadın, 117’si (%60,94) erkekti. Ortalama yaş 67 (23: 89) ve ortalama takip süresi 20 (2: 63) ay idi. Metastatik lenf nodu tutulumuna göre N0, N1, N2a ve N2b hasta sayısı sırasıyla 101, 57, 20, 14 idi. Metastatik lenf nodu tutulumu ile yaş, cinsiyet NLO, LMO arasında anlamlı bir ilişki bulunmadı. Metastatik lenf nodu sayısı arttıkça sağ kalım azalmaktadır.( p=0.002). Histopatolojik grade, t evresi, LVİ, PNİ, artmış tümör çapı, çıkartılan total lenf nodu sayısı ve artmış monosit sayısı metastatik lenf nodu tutulumu ile anlamlı olarak ilişkili bulundu.
TARTIŞMA ve SONUÇ: Çalışmamızda standart prognostik faktörler haricinde artmış monosit sayısı lenf nodu tulumu ile ilişkili bulundu. Minimal invaziv cerrahi planlanan veya evre Ⅱ hastalarda monosit sayısı yüksek olması durumunda ihtiyatlı davranmak gerektiğini ve tedavi planın buna göre yapılmasını öneriyoruz.

References

  • 1. Corman ML. Carcinoma of the Colon. In: Corman ML (Ed.) Colon & Rectal Surgery. 5th Ed. 767-903, Lippincot Williams & Wilkins, Philadelphia, 2005
  • 2. U.S. Cancer Statistics Working Group. United States cancer statistics: 2002 Incidence and mortality web-based report version. Centers for Disease Control and Prevention, and National Cancer Institute, 2005. Available at http://www. cdc.gov/cancer/npcr/uscs, http://seer.cancer.gov/statistics, accessed January 18, 2006
  • 3. Fry RD, Mahmoud N, Maron DJ, Ross HM. Colon and Rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL (Eds.) Sabiston Textbook of Surgery. 18th Ed. 1348-1432, Saunders Elsevier, Philadelphia, 2008
  • 4. TÜİK.Ölüm nedeni istatistikleri, 2017. tuikweb.tuik.gov.tr/PreHaberBultenleri.do.id=27592
  • 5. Hari DM, Leung AM, Lee JH, et al. AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg 2013;217:181–90.
  • 6. Benson AB, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004; 22: 3408-19.
  • 7. Hermanek P. Prognostic factor research in oncology. J Clin Epidemiol 1999; 52:371-374
  • 8. Sarli L, Bader G, Lusco D, et al. Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 2005;41:272-279
  • 9. Johnson PM, Poster GA, Ricciordi R and Baxter NN. Increasing negative lymph node count is independently associated with improved long term survival in stage IIIB and IIIC colon cancer. J Clin Oncol 2006;24:3570-3575
  • 10. Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD. The ASCRS Textbook of Colon and Rectal Surgery. Bleday R, Garcia-Aguilar J, Surgical Treatment of Rectal Cancer. Springer, New York, 2007; 413-436
  • 11. Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinoma arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985;89: 328-36.
  • 12. Haggitt RC. Management of the patients with Carcinomas in an adenoma. Prog Clin Biol Res 1988;279: 89-99.
  • 13.Wang HS, Liang WY, Lin TC, et al. Curative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis. Dis Colon Rectum 2005;48: 1182–1192.
  • 14. Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003;10(1):65-71.
  • 15. Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, et al. Prognostic evalution of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of secondary analysis of a large scale adjuvant trial. Ann Surg 2002;235(/4):458-63
  • 16. Hermanek P, Gospodarowicz MK, Henson DE, et al. International Union Against Cancer (IUCC): Prognostic factors in cancer. Berlin. Springer New York, 1995.
  • 17. Wolmark N, Wieand HS, Rockette HE, et al. The prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Findings from the NSABP clinical trials. Ann Surg 1983;198:743-752.
  • 18. Xu FY, Di MJ, Dong JK, et al. Influence of clinical and pathomorphological parameters on prognosis in colon carcinoma and rectal carcinoma. Zhejiang Da Xue Xue Bao Yi Xue Ban 2006;35: 303–310
  • 19. Park YJ, Park KJ, Park JG, et al. Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg 1999;23: 721-726.
  • 20. Minsky BD, Miles C, Rich TA, et al. Lymphatic vessel invasion as an independent prognostic factors for survival in colorectal cancer. Int Radiat Oncol Biol Phys 1989;17: 311-18.
  • 21. Weiser MR, Landmann RG, Kattan MW, et al. Individualized prediction of colon cancer recurrence using nomogram. J Clin Oncol 2008;26:380-85.
  • 22. Sökmen S. Kolorektal Kanserde Prognoz, Kolorektal Özel Sayısı. Türkiye Klinikleri Journal of Surgery 2004;9: 57-65.
  • 23. Benek S, Tatar C, Kocakusak A, Ozer B, Kizilkaya MC, Aydin H. The effect of demographic, biochemical and patholojical parameters on survival in colorectal cancer. J Turgut Ozal Med Cent 2016;23(4):414-9.
  • 24. Minsky BD, Mies C, Rich TA, Recht A. Lymphatic vessel invasion is an independent prognostic factor for survival in colorectal cancer. International Journal of Radiation Oncology* Biology* Physics. 1989; 17(2): 311-8
  • 25. Saclarides TJ, Bhattacharyya AK, Britton-Kuzel C, Szeluga D, Economou SG. Predicting lymph node metastases in rectal cancer. Dis Colon Rectum 1994; 37: 2-57.
  • 26. Shirouzu K, Isomoto H, Kakegawa T. Prognostic evaluation of perineurotic invasion in rectal cancer. AM J Surg. 1993;165:233-37
  • 27. Fujita S, Shimoda T, Yoshimura K, et al. Prospective evaluation of prognostic factors in patients with colorectal cancer undergoing curative resection. J Surg Oncol 2003; 84: 127-31
  • 28. Batsakis J. Nerves and neurotropic carcinomas. The Annals of otology, rhinology, and laryngology. 1985; 94(4 Pt 1):426.
  • 29. Luo XL, He W, Huang H, et al. Design of a prognostic score model for nasopharyngeal carcinoma. Head Neck. In press. Head & Neck 2015; 37: 624-629
  • 30. Tsai YD, Wang CP, Chen CY, et al. Pretreatment circulating monocyte count associated with poor prognosis in patients with oral cavity cancer. Head Neck 2014; 36: 947– 953.
There are 30 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Articles
Authors

Suat Benek 0000-0003-0774-7695

Sami Açar 0000-0003-4096-3963

Publication Date December 15, 2022
Submission Date August 29, 2022
Published in Issue Year 2022 Volume: 2 Issue: 3

Cite

Vancouver Benek S, Açar S. Associated Factors of The Metastatic Lymph Node Involvement in Colorectal Cancers. HMJ. 2022;2(3):7-14.

e-ISSN: 2791-9935