Number of negative lymph nodes with a positive impact on survival of stage III colon cancer; a retrospective observation study for right side and left side colon

Yi-Hung Kuo,Chih-Chien Chin,Jy-Ming Chiang,Hsin-Yuan Hung,Chia-Hao Chang,Jeng-Fu You

doi:10.1186/s12885-021-09154-z

Abstract

BackgroundThe purpose was to examine the effect of negative lymph nodes (NLN) number on survival in stage III colon cancer. To reduce the interference of acute inflammation, we included patients with stage III colon cancer who had undergone elective surgery and excluded those who had tumor perforation, obstruction, ischemia, or massive tumor bleeding.MethodsThis retrospective cohort study included 2244 patients with stage III colon cancer between 1995 and 2016 at a single center. The effect of NLN on 5-year relapse-free survival (RFS), 5-year overall survival (OS), and comparison of multivariate factors was assessed according to tumor locations.ResultsThe two optimal cutoff values of NLN for proximal and distal colon, namely 27 and 12, were determined by plotting the time-dependent receiver operating characteristic curve. Overall, 499 of 891 and 1020 of 1353 patients with right-side and left-side colon cancer, respectively, had high NLN. In right-side colon cancer, patients with high NLN (≥ 27) had superior OS (74.9% vs. 62.7%, P < 0.001) and RFS (75.0% vs. 61.9%, P < 0.001) than did those with low NLN. Moreover, in left-side colon cancer, patients with high NLN (≥12) experienced significantly superior OS (80.8% vs. 68.6%, P < 0.001) and RFS (77.3% vs. 66.2%, P < 0.001) than did those with low NLN. Among the different subgroups of stage III colon cancer, the high NLN group showed significantly superior RFS and OS in stage IIIB (RFS: 77.0% vs. 68.0%, P = 0.001; OS: 78.6% vs. 67.9%, P < 0.001) and IIIC (RFS: 58.2% vs. 44.1%, P = 0.001; OS: 65.7% vs. 51.1%, P < 0.001) colon cancer. However, in stage IIIA colon cancer, high NLN only showed survival benefit in OS (91.5% vs. 89.8%, P = 0.041). Multivariate analyses confirmed that high NLN, high carcinoembryonic antigen (≥ 5 ng/mL) level, and stage IIIC status are three independent prognostic factors in both the proximal and distal colon.ConclusionsNLN is a crucial prognostic factor for stage III colon cancer in various tumor locations or in the subgroups of stage III disease. In advanced stage III colon cancer, the importance of NLN and its role in anti-cancer immune response could be highlighted.

Highlights

The purpose was to examine the effect of negative lymph nodes (NLN) number on survival in stage III colon cancer
A brief description This study explored the relationship of negative lymph nodes (NLN) to the long-term outcome of stage III colon cancer
Because an association existed between local or systemic inflammatory response syndrome and lymphadenopathy, only patients with stage III colon cancer without cancer obstruction, cancer perforation, ischemic colitis resulting from obstruction, or combinations of the aforementioned conditions were included in the present analysis

Summary

Introduction

The purpose was to examine the effect of negative lymph nodes (NLN) number on survival in stage III colon cancer. The tumor, node, and metastasis (TNM) stage, which is determined on the basis of the extent of tumor invasion and the status of lymph node metastasis and distant metastasis, is considered one of the most predictable prognostic factors [2]. Many studies have determined parameters associated with the lymph node status of CRC, including the number of lymph node harvest in stage II disease, metastatic lymph node ratio, and the number of negative lymph node (NLN) in stage III disease [3,4,5,6,7,8,9]. The number of NLN as a prognostic factor still is interesting when we consider the possible association between a patient’s immune response and their survival. Patients’cancer recurrence at 5 years was 8, 19, and 32% in high, intermediate, and low Immunoscore groups [13]

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Results

Conclusion