Abstract
BackgroundMore extensive lymphadenectomy may improve survival after resection of colonic cancer. Nomograms were created predicting overall survival and recurrence for patients who undergo D2–D3 lymph node dissection, and their validity determined.MethodsThis was a multicentre study of patients with colonic cancer who underwent resection with D2–D3 lymph node dissection in Japan. Inclusion criteria included R0 resection. A training cohort of patients operated on from 2007 to 2008 was analysed to construct prognostic models predicting survival and recurrence. Discrimination and calibration were performed using an external validation cohort from the Japanese colorectal cancer registry (procedures in 2005–2006).ResultsThe training cohort consisted of 2746 patients. Predictors of survival were: age (hazard ratio (HR) 1·04), female sex (HR 0·71), depth of tumour invasion (HR 1·15, 1·22, 2·96 and 3·14 for T2, T3, T4a and T4b respectively versus T1), lymphatic invasion (HR 1·11, 1·15 and 2·95 for ly1, ly2 and ly3 versus ly0), preoperative carcinoembryonic antigen (CEA) level (HR 1·21, 1·59 and 1·99 for 5·1–10·0, 10·1–20·0 and 20·1 and over versus 0–5·0 ng/ml), number of metastatic lymph nodes (HR 1·07), number of lymph nodes examined (HR 0·98) and extent of lymphadenectomy (HR 0·23, 0·13 and 0·11 for D1, D2 and D3 versus D0). Predictors of recurrence were: female sex (HR 0·82), macroscopic type (HR 3·82, 4·56, 6·66, 7·74 and 3·22 for types I, II, III, IV and V versus type 0), depth of invasion (HR 1·25, 2·66, 5·32 and 6·43 for T2, T3, T4a and T4b versus T1), venous invasion (HR 1·43, 3·05 and 4·79 for v1, v2 and v3 versus v0), preoperative CEA level (HR 1·39, 1·43, 1·56 and 1·85 for 5·1–10·0, 10·1–20·0, 20·1–40·0 and 40·1 or more versus 0–5 ng/ml), number of metastatic lymph nodes (HR 1·07) and number of lymph nodes examined (HR 0·98). The validation cohort comprised 4446 patients. The internal and external validated Harrell's C‐index values for the nomogram predicting survival were 0·75 and 0·74 respectively. Corresponding values for recurrence were 0·78 and 0·75.ConclusionThese nomograms could predict survival and recurrence after curative resection of colonic cancer.
Highlights
Colonic cancer is common worldwide, and radical resection of the colon combined with regional lymph node dissection is the core of non-metastatic colonic cancer treatment[1]
In the multivariable model of overall survival (OS), hazard ratios were significantly higher for older age, male sex, less extensive lymph node dissection, higher preoperative carcinoembryonic antigen (CEA) level, greater depth of invasion, higher grade of lymphatic invasion, increased number of metastatic lymph nodes and decreased number of lymph nodes examined (Table 2)
For recurrence-free survival (RFS), hazard ratios in the multivariable model were significantly higher for male sex, advanced macroscopic type, higher preoperative CEA level, greater depth of invasion, higher grade of venous invasion, increased number of metastatic lymph nodes and decreased number of lymph nodes examined (Table 3)
Summary
Colonic cancer is common worldwide, and radical resection of the colon combined with regional lymph node dissection is the core of non-metastatic colonic cancer treatment[1]. In Japan, colectomy with D3 lymph node dissection is performed routinely for T3 and T4 colonic cancer with low morbidity and mortality rates[4,5,6]. This dissection technique emphasizes anatomical lymph node dissection, BJS Open 2019; 3: 539–548. Nomograms were created predicting overall survival and recurrence for patients who undergo D2–D3 lymph node dissection, and their validity determined. Methods: This was a multicentre study of patients with colonic cancer who underwent resection with D2–D3 lymph node dissection in Japan. Conclusion: These nomograms could predict survival and recurrence after curative resection of colonic cancer. Presented to a meeting of the Japanese Society for Cancer of the Colon and Rectum, Iwate, Japan, January 2017
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