Purpose
Lymph node metastasis is an important factor for predicting the prognosis of colorectal cancer patients. However, approximately 60% of patients do not receive adequate lymph node evaluation (less than 12 lymph nodes). In this study, we identified a more effective tool for predicting the prognosis of patients who received inadequate lymph node evaluation.
Materials and Methods
The number of metastatic lymph nodes, total number of lymph nodes examined, number of negative metastatic lymph nodes (NL), lymph node ratio (LR), and the number of apical lymph nodes (APL) were examined, and the prognostic impact of these parameters was examined in patients with colorectal cancer who underwent surgery from January 2004 to December 2011. In total, 806 people were analyzed retrospectively.
Results
In comparison of different lymph node analysis methods for rectal cancer patients who did not receive adequate lymph node dissection, the LR showed a significant difference in overall survival (OS) and the APL predicted a significant difference in disease-free survival (DFS). In the case of colon cancer patients who did not receive adequate lymph node dissection, LR predicted a significant difference in DFS and OS, and the APL predicted a significant difference in DFS.
Conclusion
If patients did not receive adequate lymph node evaluation, the LR and NL were useful parameters to complement N stage for predicting OS in colon cancer, whereas LR was complementary for rectal cancer. The APL could be used for prediction of DFS in all patients.
Citations
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PURPOSE Cancer-related inflammation affects many aspects of malignancy. We confirm the effects of early postoperative systemic inflammation on cancer prognosis. MATERIALS AND METHODS Six hundred consecutive patients underwent surgery for colorectal cancer from 2006 to 2009.
Measurements of white blood cells, neutrophils, lymphocytes, monocytes, and platelet counts were performed preoperatively, daily until the fourth postoperative day, and subsequently every two days. Patients were divided into three groups based on the days spent on the leukocyte count to drop below 10,000/mm3 after surgery. RESULTS Preoperative white blood cell (WBC) counts correlated with stage of disease. In univariate survival analyses, tumor, node, metastasis (TNM) stage, and monocyte count were associated with cancer-free survival. In addition, cancer-free survival outcomes were worse in patients who required more than four days for the normalization of WBC count. A TNM stage greater than II and the neutrophil lymphocyte ratio were associated with the duration of overall survival. In a multivariate analysis of these significant variables, TNM stage, an interval longer than four days for normalization of WBC counts and monocyte count independently associated with cancer-free survival. CONCLUSION Postoperative early inflammatory phase and preoperative monocyte count correlate with poor colon cancer prognosis. We can conclude that preoperative and postoperative inflammatory response and period unfavorably affect the metastatic microenvironment.
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Elevated peripheral absolute monocyte count related to clinicopathological features and poor prognosis in solid tumors: Systematic review, meta‐analysis, and meta‐regression Shu Wen, Nan Chen, Ying Hu, Litao Huang, Jin Peng, Meina Yang, Xiaoyang Shen, Yang Song, Liangzhi Xu Cancer Medicine.2021; 10(5): 1690. CrossRef
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Prognostic significance of pretreatment elevated platelet count in patients with colorectal cancer: a meta-analysis Yu Long, Ting Wang, Qian Gao, Chengya Zhou Oncotarget.2016; 7(49): 81849. CrossRef
Impact of a lymphocyte to monocyte ratio in stage IV colorectal cancer Tsuyoshi Ozawa, Soichiro Ishihara, Kazushige Kawai, Shinsuke Kazama, Hironori Yamaguchi, Eiji Sunami, Joji Kitayama, Toshiaki Watanabe Journal of Surgical Research.2015; 199(2): 386. CrossRef
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