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Open Access 01-08-2016 | Colorectal Cancer

Clinical Significance of Extramural Tumor Deposits in the Lateral Pelvic Lymph Node Area in Low Rectal Cancer: A Retrospective Study at Two Institutions

Authors: Ryoma Yagi, MD, Yoshifumi Shimada, MD, PhD, Hitoshi Kameyama, MD, PhD, Yosuke Tajima, MD, Takuma Okamura, MD, PhD, Jun Sakata, MD, PhD, Takashi Kobayashi, MD, PhD, Shin-ichi Kosugi, MD, PhD, Toshifumi Wakai, MD, PhD, Hitoshi Nogami, MD, PhD, Satoshi Maruyama, MD, PhD, Yasumasa Takii, MD, PhD, Takashi Kawasaki, MD, PhD, Kei-ichi Honma, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 4/2016

Abstract

Background

The presence of extramural tumor deposits without lymph node structure (EX) is an important prognostic factor for patients with colorectal cancer. However, the clinical significance of EX in the lateral pelvic lymph node area (LP-EX) remains unclear. This study aimed to determine the prognostic implications of LP-EX for patients with low rectal cancer.

Methods

This retrospective study involved 172 consecutive patients with stage 2 or 3 low rectal cancer who underwent curative surgery including lateral pelvic lymph node (LPLN) dissection. The patients were classified into the following three groups according to the metastatic status of the LPLN area: patients without metastasis (no-LP-M group), patients with lymph node metastasis (LP-LNM group), and patients with EX (LP-EX group). Potential prognostic factors of overall survival (OS) and relapse-free survival (RFS) were identified in uni- and multivariate analyses.

Results

Classification assigned 131 patients (76 %) to the no-LP-M group, 27 patients (16 %) to the LP-LNM group, and 14 patients (8 %) to the LP-EX group. The 5-year OS rate was 80.3 % in the no-LP-M group, 61.1 % in the LP-LNM group, and 34.9 % in the LP-EX group (P < 0.001). The corresponding 5-year RFS rates were 62.2, 33.8, and 14.3 %, respectively (P < 0.001). A multivariate Cox proportional hazards regression analysis showed that the presence of LP-EX was an independent prognostic factor for OS (P = 0.006) and RFS (P = 0.001).

Conclusions

The LP-EX classification is a useful pathologic parameter that can be used to stratify patients with metastasis in the LPLN area.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology-Rectal Cancer. Version 2, 2015. http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Retrieved 29 May 2015.

Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, Tekkis P. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol. 2009;10:1053–62.CrossRefPubMed

Kusters M, Beets GL, van de Velde CJ, et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg. 2009;249:229–35.CrossRefPubMed

Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum. 1989;32:307–15.CrossRefPubMed

Sugihara K, Kobayashi H, Kato T, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49:1663–72.CrossRefPubMed

Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K. Japanese Society for Cancer of the Colon and Rectum. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg. 2012;255:1129–34.CrossRefPubMed

Hida J, Yasutomi M, Tokoro T, Kubo R. Examination of nodal metastases by a clearing method supports pelvic plexus preservation in rectal cancer surgery. Dis Colon Rectum. 1999;42:510–14.CrossRefPubMed

Sugihara K, Moriya Y, Akasu T, Fujita S. Pelvic autonomic nerve preservation for patients with rectal carcinoma: oncologic and functional outcome. Cancer. 1996;78:1871–80.CrossRefPubMed

Kinugasa T, Akagi Y, Ochi T, et al. Lateral lymph-node dissection for rectal cancer: meta-analysis of all 944 cases undergoing surgery during 1975–2004. Anticancer Res. 2013;33:2921–7.PubMed

10.

Paty PB, Enker WE, Cohen AM, Lauwers GY. Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 1994;219:365–73.CrossRefPubMedPubMedCentral

11.

Harrison JC, Dean PJ, el-Zeky F, Vander Zwaag R. Impact of the Crohn’s-like lymphoid reaction on staging of right-sided colon cancer: results of multivariate analysis. Hum Pathol. 1995;26:31–8.CrossRefPubMed

12.

Goldstein NS, Turner JR. Pericolonic tumor deposits in patients with T₃ N + M₀ colon adenocarcinomas: markers of reduced disease free survival and intraabdominal metastases and their implications for TNM classification. Cancer. 2000;88:2228–38.CrossRefPubMed

13.

Ueno H, Mochizuki H, Hashiguchi Y, et al. Extramural cancer deposits without nodal structure in colorectal cancer: optimal categorization for prognostic staging. Am J Clin Pathol. 2007;127:287–94.CrossRefPubMed

14.

Puppa G, Maisonneuve P, Sonzogni A, et al. Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging. Mod Pathol. 2007;20:843–55.CrossRefPubMed

15.

Ueno H, Mochizuki H, Shirouzu K, et al. Study group for tumor deposits without lymph node structure in colorectal cancer projected by the Japanese Society for Cancer of the colon and rectum. multicenter study for optimal categorization of extramural tumor deposits for colorectal cancer staging. Ann Surg. 2012;255:739–46.CrossRefPubMed

16.

Ueno H, Hashiguchi Y, Shimazaki H, et al. Peritumoral deposits as an adverse prognostic indicator of colorectal cancer. Am J Surg. 2014;207:70–7.CrossRefPubMed

17.

Shimada Y, Takii Y. Clinical impact of mesorectal extranodal cancer tissue in rectal cancer: detailed pathological assessment using whole-mount sections. Dis Colon Rectum. 2010;53:771–8.CrossRefPubMed

18.

Fleming ID, Cooper JS, Henson DE, et al. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott Raven; 1997.

19.

Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.CrossRef

20.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

21.

Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Dutch colorectal cancer group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.CrossRefPubMed

22.

Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. 2nd ed. Tokyo: Kanehara & Co; 2009.

23.

Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR). Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20:207–39.

24.

Sauer I, Bacon HE. Influence of lateral spread of cancer of the rectum on radicability of operation and prognosis. Am J Surg. 1951;81:111–20.CrossRefPubMed

25.

Fujita S, Yamamoto S, Akasu T, Moriya Y. Prognostic factors of rectal cancer patients with lateral pelvic lymph node metastasis. Hepatogastroenterology. 2012;59:2494–7.PubMed

26.

Shirouzu K, Ogata Y, Araki Y, Sasatomi T, Nozoe Y, Nakagawa M, Matono K. Total mesorectal excision, lateral lymphadenectomy, and autonomic nerve preservation for lower rectal cancer: significance in the long-term follow-up study. Kurume Med J. 2001;48:307–19.CrossRefPubMed

27.

Ueno H, Mochizuki H, Hashiguchi Y, Hase K. Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg. 2001;234:190–7.CrossRefPubMedPubMedCentral

28.

Komori K, Kanemitsu Y, Kimura K, et al. Detailed stratification of TNM stage III rectal cancer based on the presence/absence of extracapsular invasion of the metastatic lymph nodes. Dis Colon Rectum. 2013;56:726–32.CrossRefPubMed

Title: Clinical Significance of Extramural Tumor Deposits in the Lateral Pelvic Lymph Node Area in Low Rectal Cancer: A Retrospective Study at Two Institutions
Authors: Ryoma Yagi, MD
Yoshifumi Shimada, MD, PhD
Hitoshi Kameyama, MD, PhD
Yosuke Tajima, MD
Takuma Okamura, MD, PhD
Jun Sakata, MD, PhD
Takashi Kobayashi, MD, PhD
Shin-ichi Kosugi, MD, PhD
Toshifumi Wakai, MD, PhD
Hitoshi Nogami, MD, PhD
Satoshi Maruyama, MD, PhD
Yasumasa Takii, MD, PhD
Takashi Kawasaki, MD, PhD
Kei-ichi Honma, MD, PhD
Publication date: 01-08-2016
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue Special Issue 4/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-016-5379-9

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Clinical Significance of Extramural Tumor Deposits in the Lateral Pelvic Lymph Node Area in Low Rectal Cancer: A Retrospective Study at Two Institutions

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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