Background

Extranodal extension (ENE) and log odds of positive lymph nodes (LODDS) are associated with the aggressiveness of both colon and rectal cancers. The current study evaluated the clinicopathological significance and the prognostic impact of ENE and LODDS in the colon and rectal patients independently.

Methods

The clinical and histological records of 389 colorectal cancer (CRC) patients who underwent curative surgery were reviewed.

Results

For the ENE system, 244 patients were in the ENE1 group and 145 in the ENE2 system. Compared with the ENE1 system, the patients included in the ENE2 system were prone to nerve invasion (P < 0.001) and vessel invasion (P < 0.001) with higher TNM (P = 0.009), higher T category (P = 0.003), higher N category (P < 0.001), advanced differentiation (P = 0.013), more number of positive lymph nodes (NPLN) (P < 0.001), more lymph node ratio (LNR) (P < 0.001), and a higher value of LODDS (P < 0.001). ENE was more frequent in patients with left and rectal than right cancer. For the LODDS system, 280 patients were in the LODDS1 group, and 109 in the LODDS2 group. Compared to the LODDS1 group, the patients included in the LODDS2 group were more prone to nerve invasion (P = 0.0351) and vessel invasion (P < 0.001) with a higher rate of N2 stage, less NDLN (P < 0.001), more NPLN (P < 0.001), more LNR (P < 0.001), and a higher value of ENE (P < 0.001). Based on the results in the univariable analysis, the N, NPLN, LNR, LODDS, and ENE were separately incorporated into five different Cox regression models combined with the same confounders. The multivariable Cox regression analysis demonstrated that all the five staging systems were independent prognostic factors for overall survival.

Conclusion

The current study confirmed that the LODDS stage is an independent influence on the prognosis of both CRC and CC patients. ENE is an independent influencing factor on the prognosis of both CRC and CC patients, and the prognostic impact of extracapsular lymph node was observed in both CRC and CC. The frequency of ENE increases from the proximal (right) to the distal (left) colon as well as the rectum. Therefore, combining ENE and LODDS into the current TNM system to compensate for the inadequacy of pN staging needs further investigation.

中文翻译：

---

ENE 和 LODDS 与淋巴结阳性结直肠癌位置相关的预后意义

背景

结外延伸 (ENE) 和阳性淋巴结的对数几率 (LODDS) 与结肠癌和直肠癌的侵袭性有关。目前的研究独立评估了 ENE 和 LODDS 在结肠和直肠患者中的临床病理学意义和预后影响。

方法

回顾了 389 例接受根治性手术的结直肠癌 (CRC) 患者的临床和组织学记录。

结果

对于 ENE 系统，ENE1 组中有 244 名患者，ENE2 系统中有 145 名患者。与ENE1系统相比，ENE2系统包括的患者容易发生神经侵犯（P  < 0.001）和血管侵犯（P  < 0.001），TNM较高（P  = 0.009），T类别较高（P  = 0.003），较高N类（P  < 0.001），分化晚期（P  = 0.013），阳性淋巴结（NPLN）数量（P  < 0.001），更多淋巴结比率（ LNR ）（P  < 0.001），以及更高的LODDS值( P < 0.001)。ENE 在左侧和直肠癌患者中比右侧更常见。对于 LODDS 系统，LODDS1 组中有 280 名患者，LODDS2 组中有 109 名患者。与LODDS1组相比，LODDS2组患者更易发生神经侵犯（P  = 0.0351）和血管侵犯（P  < 0.001），N2分期率更高，NDLN更少（P  < 0.001），NPLN更多( P  < 0.001)，更多的 LNR ( P  < 0.001)，以及更高的 ENE 值 ( P < 0.001)。根据单变量分析的结果，将 N、NPLN、LNR、LODDS 和 ENE 分别合并到五个不同的 Cox 回归模型中，并结合相同的混杂因素。多变量 Cox 回归分析表明，所有五个分期系统都是总生存期的独立预后因素。

结论

目前的研究证实，LODDS 分期是对 CRC 和 CC 患者预后的独立影响。ENE 是影响 CRC 和 CC 患者预后的独立影响因素，在 CRC 和 CC 中均观察到包膜外淋巴结对预后的影响。ENE 的频率从近端（右）到远端（左）结肠以及直肠增加。因此，将 ENE 和 LODDS 结合到当前的 TNM 系统中以弥补 pN 分期的不足需要进一步研究。