Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8582-8590
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8582
Prognostic value of lymph node metastasis in patients with T1-stage colorectal cancer from multiple centers in China
Zhen-Qiang Sun, Shuai Ma, Quan-Bo Zhou, Shuai-Xi Yang, Yuan Chang, Xiang-Yue Zeng, Wei-Guo Ren, Fang-Hai Han, Xiang Xie, Fan-Ye Zeng, Xian-Tao Sun, Gui-Xian Wang, Zhen Li, Zhi-Yong Zhang, Jun-Min Song, Jin-Bo Liu, Wei-Tang Yuan
Zhen-Qiang Sun, Shuai Ma, Quan-Bo Zhou, Shuai-Xi Yang, Yuan Chang, Xian-Tao Sun, Gui-Xian Wang, Zhen Li, Zhi-Yong Zhang, Jun-Min Song, Jin-Bo Liu, Wei-Tang Yuan, Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Zhen-Qiang Sun, Xiang-Yue Zeng, Department of Gastrointestinal Surgery, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Wei-Guo Ren, Department of Gastroenterology, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Fang-Hai Han, Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Xiang Xie, Department of Coronary Artery Disease, Heart Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Fan-Ye Zeng, Department of Oncology, the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Author contributions: Sun ZQ, Ma S and Zhou QB contributed equally to this work; Sun ZQ and Zhou QB designed the study and analyzed the data; Ma S, Yang SX and Chang Y performed the experiments; Ma S wrote the paper; Zeng XY, Ren WG, Han FH, Xie X, Zeng FY, Sun XT, Wang GX, Li Z, Zhang ZY, and Song JM collected the data; Liu JB and Yuan WT designed the study and revised the paper; all authors have read and approved the final version to be published.
Institutional review board statement: All tissues have been approved by the Ethics Review Committee of the First Affiliated Hospital of Zhengzhou University before they were used for research purposes.
Informed consent statement: All patients who provided clinical material signed an informed consent form.
Conflict-of-interest statement: All authors have declared that there is no conflict of interest.
Data sharing statement: No additional data are available for this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Tang Yuan, MD, PhD, Chief physician, Professor, Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou 450052, Henan Province, China. yuanweitang@zzu.edu.cn
Telephone: +1-51-49341934 Fax: +1-51-48431434
Received: July 20, 2017
Peer-review started: July 21, 2017
First decision: August 30, 2017
Revised: October 21, 2017
Accepted: November 28, 2017
Article in press: November 28, 2017
Published online: December 28, 2017
Processing time: 36 Days and 2.2 Hours
ARTICLE HIGHLIGHTS
Research background

Lymph node metastasis is the primary type of metastasis seen in advanced colorectal cancer (CRC). The occurrence rate of T1-stage CRC has been reported to be approximately 3.51%[5,6]. When the tumor is completely removed, patients with T1-stage CRC generally have a good prognosis. However, since lymph node metastasis rarely occurs in T1-stage CRC, lymph node metastasis is often overlooked during the process of diagnosis and treatment. Nevertheless, lymph node metastasis is one of the most essential prognostic factors. In this study, we explored the features and prognostic value of lymph node metastasis, which will provide a theoretical basis for more effective treatment of patients with T1-stage CRC.

Research motivation

The main topic of this study is the exploration of whether lymph node metastasis in patients with T1-stage CRC is valuable for patient survival in multiple centers in China. The key is to find the risk factors for lymph node metastasis of CRC. The significance is the confirmation of the prognostic value of lymph node metastasis in patients with T1-stage CRC.

Research objectives

Studies have reported that lymph node metastasis is an essential prognostic factor for patients with CRC and that lymph node metastasis seldom occurs in T1-stage CRC. However, the definitive prognostic value of lymph node metastasis of T1-stage CRC remains elusive. The main objective of this study was to explore the features and prognostic value of lymph node metastasis in patients with T1-stage CRC.

Research methods

The current research was a case-control study.

Research results

The occurrence rate of T1 stage CRC was 3.17% (321/10,132); of these cases, the lymph node metastasis rate was 8.41% (27/321), and the non-lymph node metastasis rate was 91.59% (294/321). Univariate analysis showed that preoperative serum CEA, preoperative serum CA199, preoperative serum CA724, vascular invasion, and degree of differentiation were associated with lymph node metastasis in T1-stage CRC. Multivariate analysis indicated that preoperative serum CA724, vascular invasion, and degree of differentiation were closely related to lymph node metastasis. Log-rank survival analysis showed that age, preoperative serum CEA, preoperative serum CA199, vascular invasion, degree of differentiation, and lymph node metastasis were prognostic factors for 5-year OS. COX regression analysis demonstrated that preoperative serum CA199 and lymph node metastasis were independent prognostic factors for 5-year OS of patients with T1-stage CRC.

Research conclusions

The morbidity of T1-stage CRC was 3.17% out of all cases of CRC. Preoperative serum CA724, vascular invasion, and degree of differentiation were independent risk factors for lymph node metastasis of T1-stage CRC. Lymph node metastasis was an independent prognostic factor of OS in patients with T1-stage CRC.

Research perspectives

T1-stage CRC is generally regarded as the early stage, easily leading to the neglect of metastasis, especially lymph node metastasis. However, the prognosis of a little part of these cases (8.41%) with lymph node metastasis will be much poorer than those without. We also analysed high risk factors of lymph node metastasis of T1-stage CRC patients. Therefore, we must pay enough attention to lymph node metastasis status of T1-stage CRC patients to guide clinic therapy. Future studies should be focused on greater verifying study to expand further clinical samples. In addition, the mechanistic study of lymph node metastasis in T1-stage CRC patients should be further explored. Multi-center prospective cohort clinical studies will be needed to further validate the conclusion. Moreover, high-throughput transcriptome or proteome screening technology will be necessary for analysing the regulators of lymph node metastasis in T1-stage CRC patients in the future.