Li Tengfei, Yang Yan, Wu Weidong, Fu Zhongmao, Cheng Feichi, Qiu Jiahui, Li Qi, Zhang Kundong, Luo Zai, Qiu Zhengjun, Huang Chen
Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Hongkou District, Shanghai 201600, China.
Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Hongkou District, Shanghai 201600, China; Graduate School of Bengbu Medical College, Bengbu 233000, China.
Transl Oncol. 2021 Nov;14(11):101190. doi: 10.1016/j.tranon.2021.101190. Epub 2021 Aug 14.
Extranodal extension (ENE) and log odds of positive lymph nodes (LODDS) are associated with the aggressiveness of both colon and rectal cancers. The current study evaluated the clinicopathological significance and the prognostic impact of ENE and LODDS in the colon and rectal patients independently.
The clinical and histological records of 389 colorectal cancer (CRC) patients who underwent curative surgery were reviewed.
For the ENE system, 244 patients were in the ENE1 group and 145 in the ENE2 system. Compared with the ENE1 system, the patients included in the ENE2 system were prone to nerve invasion (P < 0.001) and vessel invasion (P < 0.001) with higher TNM (P = 0.009), higher T category (P = 0.003), higher N category (P < 0.001), advanced differentiation (P = 0.013), more number of positive lymph nodes (NPLN) (P < 0.001), more lymph node ratio (LNR) (P < 0.001), and a higher value of LODDS (P < 0.001). ENE was more frequent in patients with left and rectal than right cancer. For the LODDS system, 280 patients were in the LODDS1 group, and 109 in the LODDS2 group. Compared to the LODDS1 group, the patients included in the LODDS2 group were more prone to nerve invasion (P = 0.0351) and vessel invasion (P < 0.001) with a higher rate of N2 stage, less NDLN (P < 0.001), more NPLN (P < 0.001), more LNR (P < 0.001), and a higher value of ENE (P < 0.001). Based on the results in the univariable analysis, the N, NPLN, LNR, LODDS, and ENE were separately incorporated into five different Cox regression models combined with the same confounders. The multivariable Cox regression analysis demonstrated that all the five staging systems were independent prognostic factors for overall survival.
The current study confirmed that the LODDS stage is an independent influence on the prognosis of both CRC and CC patients. ENE is an independent influencing factor on the prognosis of both CRC and CC patients, and the prognostic impact of extracapsular lymph node was observed in both CRC and CC. The frequency of ENE increases from the proximal (right) to the distal (left) colon as well as the rectum. Therefore, combining ENE and LODDS into the current TNM system to compensate for the inadequacy of pN staging needs further investigation.
结外侵犯（ENE）和阳性淋巴结对数比值（LODDS）与结肠癌和直肠癌的侵袭性相关。本研究分别评估了ENE和LODDS在结肠癌和直肠癌患者中的临床病理意义及预后影响。
回顾了389例行根治性手术的结直肠癌（CRC）患者的临床和组织学记录。
对于ENE系统，244例患者属于ENE1组，145例属于ENE2组。与ENE1组相比，ENE2组患者更容易发生神经侵犯（P<0.001）和血管侵犯（P<0.001），TNM分期更高（P=0.009），T分期更高（P=0.003），N分期更高（P<0.001），分化程度高（P=0.013），阳性淋巴结数量更多（NPLN）（P<0.001），淋巴结比率更高（LNR）（P<0.001），LODDS值更高（P<0.001）。左侧和直肠癌患者的ENE比右侧癌更常见。对于LODDS系统，280例患者属于LODDS1组，109例属于LODDS2组。与LODDS1组相比，LODDS2组患者更容易发生神经侵犯（P=0.0351）和血管侵犯（P<0.001），N2期发生率更高，阴性淋巴结数量更少（P<0.001），阳性淋巴结数量更多（P<0.001），LNR更高（P<0.001），ENE值更高（P<0.001）。基于单变量分析结果，将N、NPLN、LNR、LODDS和ENE分别纳入五个不同的Cox回归模型，并结合相同的混杂因素。多变量Cox回归分析表明，所有五个分期系统都是总生存的独立预后因素。
本研究证实，LODDS分期对CRC和CC患者的预后有独立影响。ENE是CRC和CC患者预后的独立影响因素，在CRC和CC中均观察到了包膜外淋巴结的预后影响。ENE的发生率从近端（右侧）结肠到远端（左侧）结肠以及直肠逐渐增加。因此，将ENE和LODDS纳入当前的TNM系统以弥补pN分期的不足需要进一步研究。
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