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12-09-2023 | Metastasis | Colorectal Cancer

Lymph Node Metastases and Associated Recurrence-Free Survival in Microsatellite Stable and Unstable Colon Cancer

Authors: Lynn Hakki, MD, Asama Khan, MD, Mithat Gonen, PhD, Zsofia Stadler, MD, Neil H. Segal, MD, PhD, Jinru Shia, MD, Maria Widmar, MD, MPH, Iris H. Wei, MD, J. Joshua Smith, MD, PhD, Emmanouil P. Pappou, MD, PhD, Garrett M. Nash, MD, MPH, Philip B. Paty, MD, Julio Garcia-Aguilar, MD, PhD, Martin R. Weiser, MD

Published in: Annals of Surgical Oncology | Issue 13/2023

Abstract

Background

In contrast to microsatellite stable (MSS) colon cancer, predictors of lymph node metastases and their association with recurrence are not well-defined in microsatellite instability (MSI) colon cancer.

Methods

A cohort of nonmetastatic colon cancer patients undergoing surgery between 2015 and 2021 were evaluated for predictors of lymph node metastases (LNMs) and their association with recurrence-free survival (RFS).

Results

Of 1466 patients included in the analyses, 361 (25 %) had MSI. Compared with MSS, MSI was associated with earlier stage, fewer LNMs in the patients with N1 or N2 disease, and fewer high-risk features. Compared with the T3–T4 MSS patients, the odds ratios for LNM were 0.52 (95% confidence interval [CI], 0.38–0.71) for the T3–T4 MSI patients, 0.27 (95% CI, 0.38–0.71) for the T1–T2 MSS patients, and 0.15 (95 % CI, 0.08–0.26) for the T1–T2 MSI patients. In both groups, LNMs were associated with T category, patient age, and venous, lymphatic, or perineural invasion. In the MSS patients, LNMs were additionally associated with patient sex and histologic grade. Compared with the MSS patients, the MSI patients with N0 and N1 disease had a better 3-year RFS. However, the MSI patients with N2 disease had a lower rate of 3-year RFS than the MSS patients (hazard ratio, 19.75 vs 4.49).

Conclusions

In MSI colon cancer, LNMs are 50 % less prevalent, but the factors associated with LNM are like those in MSS colon cancer. The improved prognosis traditionally associated with early-stage MSI colon cancers dissipates with four or more LNMs. These findings should be taken into consideration by clinicians selecting the most appropriate course of treatment for MSI colon cancer.

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Title: Lymph Node Metastases and Associated Recurrence-Free Survival in Microsatellite Stable and Unstable Colon Cancer
Authors: Lynn Hakki, MD
Asama Khan, MD
Mithat Gonen, PhD
Zsofia Stadler, MD
Neil H. Segal, MD, PhD
Jinru Shia, MD
Maria Widmar, MD, MPH
Iris H. Wei, MD
J. Joshua Smith, MD, PhD
Emmanouil P. Pappou, MD, PhD
Garrett M. Nash, MD, MPH
Philip B. Paty, MD
Julio Garcia-Aguilar, MD, PhD
Martin R. Weiser, MD
Publication date: 12-09-2023
Publisher: Springer International Publishing
Keywords: Metastasis
Colon Cancer
Colon Cancer
Published in: Annals of Surgical Oncology / Issue 13/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14270-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lymph Node Metastases and Associated Recurrence-Free Survival in Microsatellite Stable and Unstable Colon Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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