TY - JOUR
T1 - Prognostic impact and implications of extracapsular lymph node involvement in colorectal cancer
T2 - A systematic review with meta-analysis
AU - Veronese, N.
AU - Nottegar, A.
AU - Pea, A.
AU - Solmi, M.
AU - Stubbs, B.
AU - Capelli, P.
AU - Sergi, G.
AU - Manzato, E.
AU - Fassan, M.
AU - Wood, L. D.
AU - Scarpa, A.
AU - Luchini, Claudio
N1 - Publisher Copyright:
© The Author 2015.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - 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 allcause 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%).
AB - 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 allcause 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%).
KW - As well as in future oncologic staging systems
KW - Based of these results
KW - Ene should be considered from the gross sampling to the pathology report
KW - In colorectal cancer
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U2 - 10.1093/annonc/mdv494
DO - 10.1093/annonc/mdv494
M3 - Review article
C2 - 26483050
AN - SCOPUS:84960112420
SN - 0923-7534
VL - 27
SP - 42
EP - 48
JO - Annals of Oncology
JF - Annals of Oncology
IS - 1
ER -