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

医学 结直肠癌 内科学 肿瘤科 荟萃分析 危险系数 置信区间 原发性肿瘤 淋巴结 相对风险 转移 癌症
作者
Nicola Veronese,Alessia Nottegar,Antonio Pea,Marco Solmi,Brendon Stubbs,P. Capelli,Giuseppe Sergi,Enzo Manzato,Matteo Fassan,Laura D. Wood,Aldo Scarpa,Claudio Luchini
出处
期刊:Annals of Oncology [Elsevier BV]
卷期号:27 (1): 42-48 被引量:85
标识
DOI:10.1093/annonc/mdv494
摘要

BackgroundThe 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 methodsTwo 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.ResultsThirteen 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, I2 = 60%; HR = 1.69, 95% CI 1.32–2.17, P < 0.0001, I2 = 46%) and of recurrence of disease (RR = 2.07, 95% CI 1.65–2.61, P < 0.0001, I2 = 47%; HR = 2.31, 95% CI 1.54–3.44, P < 0.0001, I2 = 48%).ConclusionsBased 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.
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