Multicenter Study

. 2024 Nov 1;67(11):1423-1436.

doi: 10.1097/DCR.0000000000003347. Epub 2024 Jul 16.

Long-term Outcome After Surgical Resection of Para-aortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study

Sono Ito^{1

2}, Yusuke Kinugasa^{1

2}, Shinichi Yamauchi^{1

2}, Hiroyuki Sato³, Akihiro Hirakawa³, Soichiro Ishihara^{1

4}, Akio Shiomi^{1

5}, Yukihide Kanemitsu^{1

6}, Takeshi Suto^{1

7}, Hiroki Takahashi^{1

8}, Michio Itabashi^{1

9}, Manabu Shiozawa^{1

10}, Masaya Hiyoshi^{1

11}, Takaya Kobatake^{1

12}, Koji Komori^{1

13}, Hiroyuki Egi^{1

14}, Heita Ozawa^{1

15}, Tomohiro Yamaguchi^{1

16}, Ryo Inada^{1

17}, Masaaki Ito^{1

18}, Yasumitsu Hirano^{1

19}, Akinobu Furutani^{1

20}, Yoshitaka Tanabe^{1

21}, Hideki Ueno^{1

22}, Masayuki Ohue^{1

23}, Koya Hida^{1

24}, Kazushige Kawai^{1

25}, Eiji Sunami^{1

26}, Hideyuki Ishida^{1

27}, Kay Uehara^{1

28}, Jun Watanabe^{1

29}, Masanori Hotchi^{1

30}, Atsushi Ishibe^{1

31}, Yasumasa Takii^{1

32}, Junichiro Hiro^{1

33}, Masakatsu Numata^{1

34}, Ichiro Takemasa^{1

35}, Takeshi Kato^{1

36}, Yoshihiro Kakeji^{1

37}, Akira Hirata^{1

38}, Yoichi Ajioka³⁹

Affiliations

¹ Study Group for Para-aortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
² Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
³ Department of Clinical Biostatistics, Tokyo Medical and Dental University, Tokyo, Japan.
⁴ Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
⁵ Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
⁶ Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
⁷ Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
⁸ Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
⁹ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁰ Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
¹¹ Department of Gastrointestinal Surgery, Ibaraki Prefectural Central Hospital, Ibaraki, Japan.
¹² Department of Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan.
¹³ Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
¹⁴ Division of Gastrointestinal Surgery and Surgical Oncology, Graduate School of Medicine, Ehime University, Ehime, Japan.
¹⁵ Department of Surgery, Tochigi Cancer Center, Tochigi, Japan.
¹⁶ Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁷ Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
¹⁸ Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
¹⁹ Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
²⁰ Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan.
²¹ Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
²² Department of Surgery, National Defense Medical College, Saitama, Japan.
²³ Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan.
²⁴ Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
²⁵ Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
²⁶ Department of Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan.
²⁷ Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
²⁸ Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
²⁹ Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.
³⁰ Division of Digestive Surgery, Ehime Prefectural Central Hospital, Ehime, Japan.
³¹ Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
³² Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
³³ Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan.
³⁴ Department of Surgery, Yokohama City University, Yokohama, Japan.
³⁵ Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
³⁶ Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
³⁷ Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
³⁸ Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan.
³⁹ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.

PMID: 39012713
DOI: 10.1097/DCR.0000000000003347

Multicenter Study

Long-term Outcome After Surgical Resection of Para-aortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study

Sono Ito et al. Dis Colon Rectum. 2024.

. 2024 Nov 1;67(11):1423-1436.

doi: 10.1097/DCR.0000000000003347. Epub 2024 Jul 16.

Authors

Affiliations

¹ Study Group for Para-aortic Lymph Node Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR).
² Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
³ Department of Clinical Biostatistics, Tokyo Medical and Dental University, Tokyo, Japan.
⁴ Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
⁵ Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
⁶ Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
⁷ Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
⁸ Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
⁹ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁰ Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
¹¹ Department of Gastrointestinal Surgery, Ibaraki Prefectural Central Hospital, Ibaraki, Japan.
¹² Department of Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan.
¹³ Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
¹⁴ Division of Gastrointestinal Surgery and Surgical Oncology, Graduate School of Medicine, Ehime University, Ehime, Japan.
¹⁵ Department of Surgery, Tochigi Cancer Center, Tochigi, Japan.
¹⁶ Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁷ Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
¹⁸ Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
¹⁹ Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
²⁰ Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan.
²¹ Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
²² Department of Surgery, National Defense Medical College, Saitama, Japan.
²³ Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan.
²⁴ Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
²⁵ Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
²⁶ Department of Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan.
²⁷ Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
²⁸ Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
²⁹ Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.
³⁰ Division of Digestive Surgery, Ehime Prefectural Central Hospital, Ehime, Japan.
³¹ Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
³² Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
³³ Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan.
³⁴ Department of Surgery, Yokohama City University, Yokohama, Japan.
³⁵ Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
³⁶ Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
³⁷ Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
³⁸ Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan.
³⁹ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.

PMID: 39012713
DOI: 10.1097/DCR.0000000000003347

Abstract

Background: The significance of resection of para-aortic lymph node metastasis in colorectal cancer is controversial.

Objective: To clarify the prognosis of colorectal cancer after para-aortic lymph node metastasis resection.

Design: Multicenter retrospective study.

Settings: Thirty-six institutions in Japan participated in this study. Database and medical records at each institution were used for data collection.

Patients: Patients with resected and pathologically proven para-aortic lymph node metastasis of colorectal cancer between 2010 and 2015 were included.

Main outcome measures: Overall survival after para-aortic lymph node metastasis resection, recurrence-free survival, and recurrence patterns after R0 resection of para-aortic lymph node metastasis.

Results: A total of 133 patients were included in the primary analysis population in this study. The 5-year overall survival rate (95% CI) was 41.0% (32.0-49.8), and the median survival (95% CI) was 4.1 (3.4-4.7) years. Independent prognostic factors for overall survival were the pathological T stage (pT4 vs pT1- 3, adjusted HR: 1.91, p = 0.006), other organ metastasis (present vs absent, adjusted HR: 1.98, p = 0.005), time to metastases (synchronous vs metachronous adjusted HR: 2.02, p = 0.02), and the number of para-aortic lymph node metastasis (3 or more vs less than 3, adjusted HR: 2.13, p = 0.001). The 5-year recurrence-free survival rate (95% CI) was 21.1% (13.5-29.7), with a median (95% CI) of 1.2 (0.9-1.4) years. The primary tumor location (left- vs right-sided colon, adjusted HR: 4.77, p = 0.01; rectum vs right-sided colon, adjusted HR: 5.27, p = 0.006), other organ metastasis (present vs absent, adjusted HR: 1.90, p = 0.03), number of para-aortic lymph node metastases (3 or more vs less than 3, adjusted HR: 2.20, p = 0.001), and hospital volume (less than 10 vs 10 or more, adjusted HR: 2.18, p = 0.02) were identified as independent prognostic factors for recurrence-free survival. Para-aortic lymph node recurrence was the most common at 33.3%.

Limitations: Selection bias cannot be ruled out because of the retrospective nature of the study.

Conclusions: Less than 3 para-aortic lymph node metastases were a favorable prognostic factor for overall and recurrence-free survival. However, para-aortic lymph node metastases were considered to be a systemic disease, and the significance of resection was limited. See Video Abstract .

Resultado a largo plazo posterior a la reseccin quirrgica de metstasis en ganglios linfticos paraarticos de cncer colorrectal un estudio retrospectivo multicntrico: ANTECEDENTES:La importancia de la resección de metástasis en los ganglios linfáticos paraaórticos (PALNM) en el cáncer colorrectal (CCR) es controvertida.OBJETIVO:Aclarar el pronóstico del CCR después de la resección PALNM.DISEÑO:Estudio retrospectivo multicéntrico.ENTORNO CLINICO:Treinta y seis instituciones en Japón participaron en este estudio.PACIENTES:Pacientes con PALNM de CCR resecado y patológicamente probado entre 2010 y 2015.FUENTES DE DATOS:Base de datos y registros médicos de cada institución.PRINCIPALES MEDIDAS DE RESULTADO:Supervivencia general (SG) después de la resección PALNM, supervivencia libre de recurrencia (SLR) y patrones de recurrencia después de la resección R0 de PALNM.RESULTADOS:Se incluyó un total de 133 pacientes en la población de análisis primario de este estudio. La tasa de SG a 5 años (intervalo de confianza [IC] del 95 %) fue del 41,0 % (32,0, 49,8) y la mediana de supervivencia (IC del 95 %) fue de 4,1 (3,4, 4,7) años. Los factores de pronóstico independientes para la SG fueron el estadio T patológico (pT4 vs. pT1-3, índice de riesgo ajustado [aHR]: 1,91, p = 0,006), metástasis en otros órganos (presente vs. ausente, aHR: 1,98, p = 0,005), tiempo hasta las metástasis (síncronas vs. metacrónicas, aHR: 2,02, p = 0,02) y número de PALNM (≥3 vs. <3, aHR: 2,13, p = 0,001). La tasa de SLR a 5 años (IC del 95%) fue del 21,1% (13,5, 29,7), con una mediana (IC del 95%) de 1,2 (0,9, 1,4) años. La ubicación del tumor primario (colon del lado izquierdo vs. derecho, aHR: 4,77, p = 0,01; recto vs. colon del lado derecho, aHR: 5,27, p = 0,006), metástasis en otros órganos (presente vs. ausente, aHR: 1,90, p = 0,03), el número de PALNM (≥3 vs. <3, aHR: 2,20, p = 0,001) y el volumen hospitalario (<10 vs. ≥10, aHR: 2,18, p = 0,02) se identificaron como independientes factores pronósticos del SLR. La recurrencia de los ganglios linfáticos paraaórticos fue la más común con un 33,3%.LIMITACIONES:No se puede descartar un sesgo de selección debido a la naturaleza retrospectiva del estudio.CONCLUSIONES:Menos de tres PALNM fue un factor pronóstico favorable tanto para la SG como para la SLR. Sin embargo, las PALNM se consideraron una enfermedad sistémica y la importancia de la resección fue limitada. (Traducción- Dr. Francisco M. Abarca-Rendon ).

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References

1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7–33.
1. The Editorial Board of the Cancer Statistics in Japan. Cancer Statistics in Japan 2022. Tokyo: Foundation for Promotion of Cancer Research; 2022.
1. Wong JS, Tan GH, Teo MC. Management of para-aortic lymph node metastasis in colorectal patients: a systemic review. Surg Oncol. 2016;25:411–418.
1. Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal, Appendiceal, and Anal carcinoma: the 3d English edition [Secondary Publication]. J Anus Rectum Colon. 2019;3:175–195.
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Long-term Outcome After Surgical Resection of Para-aortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study

Affiliations

Long-term Outcome After Surgical Resection of Para-aortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials