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01-01-2014 | 2013 SSAT Plenary Presentation

Modern Chemotherapy Mitigates Adverse Prognostic Effect of Regional Nodal Metastases in Stage IV Colorectal Cancer

Authors: Alan A. Thomay, David M. Nagorney, Steven J. Cohen, Elin R. Sigurdson, Mark J. Truty, Barbara Burtness, Michael J. Hall, Yun Shin Chun

Published in: Journal of Gastrointestinal Surgery | Issue 1/2014

Abstract

Background

In colorectal cancer, the involvement of regional lymph nodes with metastasis is an established prognostic factor. The impact of the number of positive nodes on patient outcome with stage IV disease is not well defined.

Methods

A retrospective review was performed of 1,421 patients at two tertiary referral centers with stage IV colorectal cancer who underwent primary tumor resection. Associations between regional nodes, lymph node ratio (LNR), and overall survival (OS) from date of diagnosis were analyzed.

Results

The number of positive regional nodes and LNR correlated with multiple sites of metastases (p < 0.001). Survival was significantly associated with the number of positive nodes and LNR, with a median OS of 43 months with negative nodes, compared to 20 months with ≥7 positive nodes (p < 0.001). The number of regional nodal metastases correlated with OS among 400 patients undergoing resection of liver metastases (p = 0.005) but lost prognostic significance in the subset of 223 patients who underwent hepatectomy with perioperative oxaliplatin- or irinotecan-based chemotherapy (p = 0.48).

Conclusions

In stage IV colorectal cancer, an increasing number of positive regional nodes and LNR correlate with multiple sites of metastases and poorer survival. The number of metastatic regional lymph nodes loses prognostic significance with modern chemotherapy in patients undergoing resection of liver metastases.

Kanemitsu Y, Kato T. Prognostic models for predicting death after hepatectomy in individuals with hepatic metastases from colorectal cancer. World J Surg 2008;32:1097–107.PubMedCrossRef

Kattan MW, Gonen M, Jarnagin WR, DeMatteo R, D’Angelica M, Weiser M, Blumgart LH, Fong Y. A nomogram for predicting disease-specific survival after hepatic resection for metastatic colorectal cancer. Ann Surg 2008;247:282–7.PubMedCrossRef

Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Grothey A, Vauthey JN, Larson DW, Nagorney DM, McWilliams RR. Improved Survival in Metastatic Colorectal Cancer Is Associated with Sequential Adoption of Hepatic Resection and Improved Chemotherapy: A Large Clinic-Based Analysis of Two Institutions. J Clin Oncol 2009;27:3677–3683.PubMedCrossRef

Blazer DG, 3rd, Kishi Y, Maru DM, Kopetz S, Chun YS, Overman MJ, Fogelman D, Eng C, Chang DZ, Wang H, Zorzi D, Ribero D, Ellis LM, Glover KY, Wolff RA, Curley SA, Abdalla EK, Vauthey JN. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol 2008;26:5344–51.PubMedCrossRef

Kornprat P, Jarnagin WR, Gonen M, DeMatteo RP, Fong Y, Blumgart LH, D’Angelica M. Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol 2007;14:1151–60.PubMedCrossRef

Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 2003;90:956–62.PubMedCrossRef

Zakaria S, Donohue JH, Que FG, Farnell MB, Schleck CD, Ilstrup DM, Nagorney DM. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg 2007;246:183–91.PubMedCrossRef

Stelzner S, Hellmich G, Koch R, Ludwig K. Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol 2005;89:211–7.PubMedCrossRef

Ayez N, Lalmahomed ZS, van der Pool AE, Vergouwe Y, van Montfort K, de Jonge J, Eggermont AM, Ijzermans JN, Verhoef C. Is the clinical risk score for patients with colorectal liver metastases still useable in the era of effective neoadjuvant chemotherapy? Ann Surg Oncol 2011;18:2757–63.PubMedCentralPubMedCrossRef

10.

Cardona K, Mastrodomenico P, D’Amico F, Shia J, Gonen M, Weiser MR, Paty PB, Kingham TP, Allen PJ, De Matteo RP, Fong Y, Jarnagin WR, D’Angelica MI. Detailed pathologic characteristics of the primary colorectal tumor independently predict outcome after hepatectomy for metastases. Ann Surg Oncol 2013;20:148–54.PubMedCrossRef

11.

Chun YS, Vauthey JN. Extending the frontiers of resectability in advanced colorectal cancer. Eur J Surg Oncol 2007;33 Suppl 2:S52-8.PubMedCrossRef

12.

Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005;23:8706–12.PubMedCrossRef

13.

Valsangkar NP, Bush DM, Michaelson JS, Ferrone CR, Wargo JA, Lillemoe KD, Fernandez-del Castillo C, Warshaw AL, Thayer SP. N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma. J Gastrointest Surg 2013;17:257–66.PubMedCentralPubMedCrossRef

14.

Derwinger K, Gustavsson B. A study of lymph node ratio in stage IV colorectal cancer. World J Surg Oncol 2008;6:127.PubMedCentralPubMedCrossRef

15.

Gonsalves WI, Wolpert J, Tashi T, Ganti AK, Subbiah S, Ternent C, Silberstein PT. Assessment of prognostic factors after primary tumor resection in metastatic colon cancer patients: a Veteran’s Affairs Central Cancer Registry (VACCR) analysis, 1995–2008. J Surg Oncol 2012;106:486–90.PubMedCrossRef

Title: Modern Chemotherapy Mitigates Adverse Prognostic Effect of Regional Nodal Metastases in Stage IV Colorectal Cancer
Authors: Alan A. Thomay
David M. Nagorney
Steven J. Cohen
Elin R. Sigurdson
Mark J. Truty
Barbara Burtness
Michael J. Hall
Yun Shin Chun
Publication date: 01-01-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 1/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2329-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Modern Chemotherapy Mitigates Adverse Prognostic Effect of Regional Nodal Metastases in Stage IV Colorectal Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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