Abstract
BackgroundLymph node involvement is one of the most important prognostic factors in colon cancer. Twelve is considered the minimum number of lymph nodes necessary to retain reliable tumour staging, but several factors can potentially influence the lymph node harvesting. Emergent surgery for complicated colon cancer (perforation, occlusion, bleeding) could represent an obstacle to reach the benchmark of 12 nodes with an accurate lymphadenectomy. So, an efficient classification system of lymphatic involvement is crucial to define the prognosis, the indication to adjuvant therapy and the follow-up. This is the first study with the aim to evaluate the efficacy of lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in the prognostic assessment of patients who undergo to urgent surgery for complicated colonic cancer.MethodsThis is a retrospective study carried out on patients who underwent urgent colonic resection for complicated cancer (occlusion, perforation, bleeding, sepsis). We collected clinical, pathological and follow-up data of 320 patients. Two hundred two patients met the inclusion criteria and were distributed into three groups according to parameter N of TNM, LNR and LODDS. Survival analysis was performed by Kaplan-Meier curves, investigating both overall survival (OS) and disease-free survival (DFS).ResultsThe median number of harvested lymph nodes was 17. In 78.71% (n = 159) of cases, at least 12 lymph nodes were examined. Regarding OS, significant differences from survival curves emerged for ASA score, surgical indication, tumour grading, T parameter, tumour stage, N parameter, LNR and LODDS. In multivariate analysis, only LODDS was found to be an independent prognostic factor.Concerning DFS, we found significant differences between survival curves of sex, surgical indication, T parameter, tumour stage, N parameter, LNR and LODDS, but none of these confirmed its prognostic power in multivariate analysis.ConclusionsWe found that N, LNR and LODDS are all related to 5-year OS and DFS with statistical significance, but only LODDS was found to be an independent prognostic factor for OS in multivariate analysis.
Highlights
Lymph node involvement is one of the most important prognostic factors in colon cancer
Regarding overall survival (OS) (Table 1), significant differences from survival curves emerged for American Society of Anesthesiologists (ASA) score, surgical indication, tumour grading, T parameter, tumour stage, N parameter, lymph nodes ratio (LNR) and Log odds of positive lymph nodes (LODDS)
We found that N, LNR, and LODDS are all related to 5-year OS (Figs. 1, 2 and 3) and disease-free survival (DFS) (Figs. 4, 5 and 6) with statistical significance, but only LODDS was found to be an independent prognostic factor for OS in multivariate analysis
Summary
Lymph node involvement is one of the most important prognostic factors in colon cancer. An efficient classification system of lymphatic involvement is crucial to define the prognosis, the indication to adjuvant therapy and the follow-up This is the first study with the aim to evaluate the efficacy of lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in the prognostic assessment of patients who undergo to urgent surgery for complicated colonic cancer. Emergency surgery for complicated colon cancer can represent a trouble for the surgeon, who could come across the necessity to balance the importance of an adequate oncologic resection with the opportunity of a quick control of the septic source and obtaining the hemodynamic stabilization of the patient [3, 4] This is why emergency surgery can be an obstacle to reach the benchmark of 12 nodes with an accurate lymphadenectomy, in addition to all other variables that can influence the nodal harvesting
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