Cancer Res Treat.  2019 Jul;51(3):1135-1143. 10.4143/crt.2018.392.

Prognostic Implications of Extranodal Extension in Relation to Colorectal Cancer Location

Affiliations
  • 1Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jckim@amc.seoul.kr
  • 2Department of Pathology, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3School of Life Science, Kyungpook National University, Daegu, Korea.

Abstract

PURPOSE
Extranodal extension (ENE) is closely associated with the aggressiveness of both colon and rectal cancer. This study evaluated the clinicopathologic significance and prognostic impact of ENE in separate populations of patients with colon and rectal cancers.
MATERIALS AND METHODS
The medical records of 2,346 patients with colorectal cancer (CRC) who underwent curative surgery at our institution between January 2003 and December 2011 were clinically and histologically reviewed.
RESULTS
ENE was associated with younger age, advanced tumor stage, lymphovascular invasion (LVI), and perineural invasion (PNI) in both colon and rectal cancer. ENE rates differed significantly in patients with right colon (36.9%), left colon (42.6%), and rectal (48.7%) cancers (right vs. left, p=0.037; left vs. rectum, p=0.009). The 5-year disease-free survival (DFS) rate according to ENE status and primary tumor site differed significantly in patients with ENE-negative colon cancer (80.5%), ENE-negative rectal cancer (77.4%), ENE-positive colon cancer (68.6%), and ENE-positive rectal cancer (64.2%) (p<0.001). Multivariate analysis showed that advanced tumor stage, ENE, LVI, PNI, and absence of adjuvant chemotherapy were independently prognostic of reduced DFS in colon and rectal cancer patients.
CONCLUSION
ENE is closely associated with the aggressiveness of colon and rectal cancers, with its frequency increasing from the right colon to the left colon to the rectum. ENE status is a significant independent predictor of DFS in CRC patients irrespective of tumor location. ENE might be more related with distally located CRC.

Keyword

Colonic neoplasms; Rectal neoplasms; Extranodal extension; Prognosis

MeSH Terms

Chemotherapy, Adjuvant
Colon
Colonic Neoplasms
Colorectal Neoplasms*
Disease-Free Survival
Humans
Medical Records
Multivariate Analysis
Prognosis
Rectal Neoplasms
Rectum
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