Cancer Res Treat.  2018 Jul;50(3):712-719. 10.4143/crt.2017.100.

Which Patients with Isolated Para-aortic Lymph Node Metastasis Will Truly Benefit from Extended Lymph Node Dissection for Colon Cancer?

• Bae SU
• Hur H
• Min BS
• Baik SH
• Lee KY
• Kim NK

• KMID: 2417860
• DOI: http://doi.org/10.4143/crt.2017.100

Abstract

PURPOSE
The prognosis of patientswith colon cancer and para-aortic lymph node metastasis (PALNM) is poor. We analyzed the prognostic factors of extramesenteric lymphadenectomy for colon cancer patients with isolated PALNM.
MATERIALS AND METHODS
We retrospectively reviewed 49 patients with PALNM who underwent curative resection between October 1988 and December 2009.
RESULTS
In univariate analyses, the 5-year overall survival (OS) and disease-free survival (DFS) rates were higher in patients with ≤ 7 positive para-aortic lymph node (PALN) (36.5% and 27.5%) than in those with > 7 PALN (14.3% and 14.3%; p=0.010 and p=0.027, respectively), and preoperative carcinoembryonic antigen (CEA) level > 5 was also correlated with a lower 5-year OS and DFS rate of 21.5% and 11.7% compared with those with CEA ≤ 5 (46.3% and 41.4%; p=0.122 and 0.039, respectively). Multivariate analysis found that the number of positive PALN (hazard ratio [HR], 3.291; 95% confidence interval [CI], 1.309 to 8.275; p=0.011) was an independent prognostic factor for OS and the number of positive PALN (HR, 2.484; 95% CI, 0.993 to 6.211; p=0.052) and preoperative CEA level (HR, 1.953; 95% CI, 0.940 to 4.057; p=0.073) were marginally independent prognostic factors for DFS. According to our prognostic model, the 5-year OS and DFS rate increased to 59.3% and 53.3%, respectively, in patients with ≤ 7 positive PALN and CEA level ≤ 5.
CONCLUSION
PALN dissection might be beneficial in carefully selected patients with a low CEA level and less extensive PALNM.

Keyword

Colonic neoplasms; Lymph nodes; Lymph node excision; Lymphatic metastasis

MeSH Terms

Carcinoembryonic Antigen
Colon*
Colonic Neoplasms*
Disease-Free Survival
Humans
Lymph Node Excision*
Lymph Nodes*
Lymphatic Metastasis
Multivariate Analysis
Neoplasm Metastasis*
Prognosis
Retrospective Studies
Carcinoembryonic Antigen

Figure

• 

  Fig. 1. (A) Five-year overall survival (OS) of patients with para-aortic lymph node metastasis (PALNM) according to the number of positive para-aortic lymph node (PALN). (B) Five-year disease-free survival (DFS) according to the number of positive PALN. (C) Five-year OS according to the preoperative carcinoembryonic antigen (CEA) level. (D) Five-year DFS according to the preoperative CEA level. (E) Five-year OS according to the prognostic model. (F) Five-year DFS according to the prognostic model.

• 

  Fig. 2. Suggested treatment strategy for colon cancer with isolated para-aortic lymph node metastasis. PALNM, para-aortic lymph node metastasis; PTR, primary tumor resection; PALND, para-aortic lymph node dissection; CTX, chemotherapy.

Reference

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