Metachronous metastasis- and survival-analysis show prognostic importance of lymphadenectomy for colon carcinomas

BMC Gastroenterology

Uwe J Roblick¹  Hans-Peter Bruch¹  Andreas Ziegler²  Martin Hoffmann¹  Erik Schlöricke¹  Hamed Esnaashari¹  Conny Bürk¹  Thomas Jungbluth¹  Philipp Hildebrand¹  Ralf Bouchard¹  Elisabeth Oevermann¹  Markus Kleemann¹  Claudia Hemmelmann²  Jens K Habermann¹  Tilman Laubert¹ 

[1] Department of Surgery, Laboratory for Surgical Research, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany;Institute of Medical Biometry and Statistics, University of Lübeck, Maria-Goeppert-Straße 1, D-23562 Lübeck, Germany

关键词: Regression analysis;    Recurrence free survival;    Survival;    Prognosis;    Metastasis;    Lymph nodes;    Colon cancer;   

Others  :  1113122
DOI  :  10.1186/1471-230X-12-24

 received in 2011-12-05, accepted in 2012-03-23,  发布年份 2012

【 摘 要 】

Background

Lymphadenectomy is performed to assess patient prognosis and to prevent metastasizing. Recently, it was questioned whether lymph node metastases were capable of metastasizing and therefore, if lymphadenectomy was still adequate. We evaluated whether the nodal status impacts on the occurrence of distant metastases by analyzing a highly selected cohort of colon cancer patients.

Methods

1,395 patients underwent surgery exclusively for colon cancer at the University of Lübeck between 01/1993 and 12/2008. The following exclusion criteria were applied: synchronous metastasis, R1-resection, prior/synchronous second carcinoma, age < 50 years, positive family history, inflammatory bowel disease, FAP, HNPCC, and follow-up < 5 years. The remaining 421 patients were divided into groups with (TM+, n = 75) or without (TM-, n = 346) the occurrence of metastasis throughout a 5-year follow-up.

Results

Five-year survival rates for TM + and TM- were 21% and 73%, respectively (p < 0.0001). Survival rates differed significantly for N0 vs. N2, grading 2 vs. 3, UICC-I vs. -II and UICC-I vs. -III (p < 0.05). Regression analysis revealed higher age upon diagnosis, increasing N- and increasing T-category to significantly impact on recurrence free survival while increasing N-and T-category were significant parameters for the risk to develop metastases within 5-years after surgery (HR 1.97 and 1.78; p < 0.0001).

Conclusions

Besides a higher T-category, a positive N-stage independently implies a higher probability to develop distant metastases and correlates with poor survival. Our data thus show a prognostic relevance of lymphadenectomy which should therefore be retained until conclusive studies suggest the unimportance of lmyphadenectomy.

【 授权许可】

   
2012 Laubert et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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