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Ann Oncol. 2016 Jan;27(1):42-8. doi: 10.1093/annonc/mdv494. Epub 2015 Oct 19.

Prognostic impact and implications of extracapsular lymph node involvement in colorectal cancer: a systematic review with meta-analysis.

Author information

1
Department of Medicine, DIMED, University of Padua, Padua.
2
Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
3
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
4
Department of Neuroscience, University of Padua, Padua, Italy.
5
Health Service and Population Research Department, King's College London, London, UK.
6
Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, USA.
7
Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy ARC-NET Research Center, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
8
Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy ARC-NET Research Center, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy claudio.luchini@katamail.com claudio.luchini@univr.it.

Abstract

BACKGROUND:

The extranodal extension (ENE) of nodal metastasis (i.e. the extension of tumor cells through the nodal capsule into the perinodal adipose tissue) has recently emerged as an important prognostic factor in different types of malignancies. However, the tumor-node-metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a systematic review and meta-analysis to determine the prognostic role of ENE in patients with lymph node-positive colorectal cancer.

MATERIALS AND METHODS:

Two independent authors searched PubMed and SCOPUS until 7 January 2015 without language restrictions. Prospective studies reporting data on prognostic parameters in subjects with colorectal cancer, comparing participants with the presence of ENE (ENE+) versus only intranodal extension (ENE-) were eligible. Data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) together with 95% confidence intervals (CIs) for time-dependent risk related to ENE+, adjusted for potential confounders.

RESULTS:

Thirteen studies including 1336 patients were identified with a median follow-up of 4.7 years. ENE was associated with a higher T stage and tumor grading. In addition, ENE was associated with a significantly increased risk of all-cause mortality (RR = 1.75; 95% CI 1.42-2.16, P < 0.0001, I(2) = 60%; HR = 1.69, 95% CI 1.32-2.17, P < 0.0001, I(2) = 46%) and of recurrence of disease (RR = 2.07, 95% CI 1.65-2.61, P < 0.0001, I(2) = 47%; HR = 2.31, 95% CI 1.54-3.44, P < 0.0001, I(2) = 48%).

CONCLUSIONS:

Based of these results, in colorectal cancer, ENE should be considered from the gross sampling to the pathology report, as well as in future oncologic staging systems.

KEYWORDS:

colon cancer; extracapsular extension; extranodal extension; lymph node metastasis; rectal cancer

PMID:
26483050
DOI:
10.1093/annonc/mdv494
[Indexed for MEDLINE]

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