Archives of surgery (Chicago, Ill. : 1960) · 2012
Predictors of lymph node count in colorectal cancer resections: data from US nationwide prospective cohort studies.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Morikawa Teppei, Tanaka Noriko, Kuchiba Aya, Nosho Katsuhiko, Yamauchi Mai, Hornick Jason L, Swanson Richard S, Chan Andrew T, Meyerhardt Jeffrey A, Huttenhower Curtis, Schrag Deborah, Fuchs Charles S, Ogino Shuji
Аннотация
OBJECTIVE: To identify factors that influence the total and negative lymph node counts in colorectal cancer resection specimens independent of pathologists and surgeons.
DESIGN: We used multivariate negative binomial regression. Covariates included age, sex, body mass index, family history of colorectal carcinoma, year of diagnosis, hospital setting, tumor location, resected colorectal length (specimen length), tumor size, circumferential growth, TNM stage, lymphocytic reactions and other pathological features, and tumor molecular features (microsatellite instability, CpG island methylator phenotype, long interspersed nucleotide element 1 [LINE-1] methylation, and BRAF, KRAS, and PIK3CA mutations).
SETTING: Two US nationwide prospective cohort studies.
PATIENTS: Patients with rectal and colon cancer (N=918).
MAIN OUTCOME MEASURES: The negative and total node counts (continuous).
RESULTS: Specimen length, tumor size, ascending colon location, T3N0M0 stage, and year of diagnosis were positively associated with the negative node count (all P.002). Mutation of KRAS might also be positively associated with the negative node count (P=.03; borderline significance considering multiple hypothesis testing). Among node-negative (stages I and II) cases, specimen length, tumor size, and ascending colon location remained significantly associated with the node count (all P.002), and PIK3CA and KRAS mutations might also be positively associated (P=.03 and P=.049, respectively, with borderline significance).
CONCLUSIONS: This molecular pathological epidemiology study shows that specimen length, tumor size, tumor location, TNM stage, and year of diagnosis are operator-independent predictors of the lymph node count. These crucial variables should be examined in any future evaluation of the adequacy of lymph node harvest and nodal staging when devising individualized treatment plans for patients with colorectal cancer.
DESIGN: We used multivariate negative binomial regression. Covariates included age, sex, body mass index, family history of colorectal carcinoma, year of diagnosis, hospital setting, tumor location, resected colorectal length (specimen length), tumor size, circumferential growth, TNM stage, lymphocytic reactions and other pathological features, and tumor molecular features (microsatellite instability, CpG island methylator phenotype, long interspersed nucleotide element 1 [LINE-1] methylation, and BRAF, KRAS, and PIK3CA mutations).
SETTING: Two US nationwide prospective cohort studies.
PATIENTS: Patients with rectal and colon cancer (N=918).
MAIN OUTCOME MEASURES: The negative and total node counts (continuous).
RESULTS: Specimen length, tumor size, ascending colon location, T3N0M0 stage, and year of diagnosis were positively associated with the negative node count (all P.002). Mutation of KRAS might also be positively associated with the negative node count (P=.03; borderline significance considering multiple hypothesis testing). Among node-negative (stages I and II) cases, specimen length, tumor size, and ascending colon location remained significantly associated with the node count (all P.002), and PIK3CA and KRAS mutations might also be positively associated (P=.03 and P=.049, respectively, with borderline significance).
CONCLUSIONS: This molecular pathological epidemiology study shows that specimen length, tumor size, tumor location, TNM stage, and year of diagnosis are operator-independent predictors of the lymph node count. These crucial variables should be examined in any future evaluation of the adequacy of lymph node harvest and nodal staging when devising individualized treatment plans for patients with colorectal cancer.
Предметные рубрики MeSH
AgedColonic NeoplasmsDNA MethylationDNA, NeoplasmFemaleHumansLymphatic MetastasisMaleMiddle AgedMolecular EpidemiologyMultivariate AnalysisMutationNeoplasm StagingProto-Oncogene ProteinsProto-Oncogene Proteins B-rafProto-Oncogene Proteins p21(ras)Rectal NeoplasmsRegression AnalysisUnited Statesras Proteins