Synchronous Resectable Metastatic Colorectal Cancer

To evaluate the value of lymph node status of primary tumors in predicting the prognosis of synchronous resectable metastatic colorectal cancer (mCRC). The characteristics of resectable mCRC are substantially different from other cancers, and the prognostic factors of resectable mCRC are still controversial. The data of 2007 patients with mCRC who received resection of the primary tumors and metastatic lesions synchronously were reviewed from the Surveillance, Epidemiology and End-Result database. The Kaplan–Meier method was used to evaluate the capacity of different prognostic factors. Univariate and multivariate logistic regression models were used to evaluate the relationship between the lymph node status and other factors. The mRNA profiles of primary resectable Jiao Yang, MD, L Lin Feng, PhD, ing Yuan, PhD according to the 7th American Joint Committee on Cancer (AJCC) Tumor Lymph Node Metastasis (TNM) N-classification (P1⁄4 0.000), and 40, 29, 22, and 15 months in patients with metastatic lymph node ratio (LNR) <0.25, 0.25–0.49, 0.5–0.74, and 0.75 subgroups (P1⁄4 0.000). In the COX model, the 7th AJCC TNM N-stage and LNR were independent prognostic factors. The mRNA profile was not associated with lymph node involvement. Both the N-stage according to the 7th AJCC TNM staging system and LNR had the capacity to subclassify synchronous resectable mCRC with different prognoses. The lymph node might be integrated into the AJCC staging system as a diagnose-delay prognostic factor for stage IV disease. (Medicine 94(30):e1215) Abbreviations: CI = confidence intervals, LNR = lymph node ratio, mCRC = metastatic colorectal cancer. INTRODUCTION C olorectal cancer is the 4th most common cancer and the second-leading cause of cancer-related death worldwide, making it a serious threat to public health. Approximately 20% of patients are diagnosed with metastatic colorectal cancer (mCRC, or stage IV colorectal cancer), and more than 1/3 of those initially diagnosed with localized disease will develop mCRC. In the 7th American Joint Committee on Cancer (AJCC) Tumor Lymph Node Metastasis (TNM) staging system, stage IV is subclassified into stage IVa (metastasis confined to one organ or site) and stage IVb (metastasis in more than one organ/site or the peritoneum). However, the clinical application of this classification has not been further validated and was called into question by Kobayashi et al. Patients with mCRC who do not undergo surgery have a shorter survival time. Radical resection is the only known method to cure the disease, and this technique could achieve a 5-year overall survival rate of 30% to 60%. There is a lack of strong evidence supporting a good clinical outcome following surgical resection, but both the European Society for Medical Oncology and National Comprehensive Cancer Network guidelines recommend radical resection as the standard therapy. Moreover, obvious heterogeneity exists in the results of resectable mCRC. Approximately 2/3 of patients with resectable mCRC will suffer recurrence and treatment failure. The most effective strategy to improve the outcome is to stratify resectable mCRC accurately and to personalize treatment. In previous studies, several risk score models were proposed to predict outcomes, but all of the models were complicated and in discord. Therefore, the prognostic factors of resectable mCRC remain controversial, and a simple and reliable factor to predict the prognoses of resectable mCRC is needed. The status of the lymph tumor was confirmed as a prognostic RC. Furthermore, the lymph node ratio d as a prognostic factor in localized www.md-journal.com | 1 CRC. However, the value of lymph node status of primary tumors in predicting the prognosis of resectable mCRC remains unclear. The current population-based analysis using the Surveillance, Epidemiology and End-Result (SEER) database was performed to confirm the predicted value of lymph node status of the primary tumor in resectable mCRC.