Stage migration resulting from inadequate number of examined lymph nodes impacts prognosis in stage II colon cancer afte
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ORIGINAL ARTICLE
Stage migration resulting from inadequate number of examined lymph nodes impacts prognosis in stage II colon cancer after radical surgery Di Xie 1 & Xiangping Song 2
&
Lingling Tong 3
Accepted: 29 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We evaluated the impact of examined lymph node (ELN) number on the prognosis of stage II colon cancer after radical surgery and developed a novel prognostic scoring system by combining primary tumor extension (pT) and ELN number for reclassification of stage II colon cancer. Methods Three cohorts of patients diagnosed with colon cancer between 2004 and 2010 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to evaluate the relationship between factors and patients’ survival including cause-specific survival (CSS) and overall survival (OS). Survival curves from subgroups were plotted by the Kaplan-Meier method and compared by the log-rank test. Results Cohort 1 and cohort 2 consisted of 13,960 and 5312 stage II colon cancer patients, respectively. Cohort 3 consisted of 4713 stage III patients. Factors including ELN, age, and pT were found to be associated with patients’ survival in cohorts 1 and 2. Patients who were older or with smaller tumors were more likely to experience inadequate ELN. Patients with a higher score, as calculated by the novel scoring system, showed worse survival. Compared with stage III colon cancer patients, stage II patients with high scores had a comparable or even worse survival than stage IIIA and IIIB patients. Conclusion Inadequate ELN leads to understaging in stage II colon cancer and predicts inferior prognosis. Our analyses show that the novel prognostic scoring system, consisting of combined pT and ELN, quantified stage migration effect and can be applied to the reclassification of stage II colon cancer. Keywords Colon cancer . Examined lymph nodes . Prognostic score system . SEER
Introduction Colon cancer is the fourth most commonly diagnosed and fifth cause of cancer-related deaths worldwide [1]. In the USA, approximately 38% of colon cancer patients diagnosed between 2006 and 2012 had localized (stage I and II) colon
* Xiangping Song [email protected] 1
Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
2
Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
3
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, People’s Republic of China
cancer and a 5-year survival rate of about 90% better than regional (stage III) colon cancer patients [2]. The standard treatment for non-metastatic colon cancer is radical surgery with or without adjuvant chemotherapy. Adjuvant chemotherapy is recommended for high-risk patients with stage II colon cancer [3, 4]. Great efforts have been made to iden
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