Background: Lymphadenectomy plays a central role in the treatment of localized colon cancer. While in left colon cancer the D3 lymphadenectomy/CME is considered the standard of care, lymphatic stations to be removed in right colon cancer are still a matter of discussion. The individuation of LNM risk factors could help in choosing the lymphadenectomy in right-sided tumors. This study aims to analyze the correlation of histopathological and molecular characteristics with lymph node metastasis, both in right- and left-sided colon cancer, and their impact on survival;Methods: We conducted a single-center observational retrospective study. The following data were collected and analyzed for each patient: demographics, histopathological and molecular data, and intraoperative and perioperative data. Statistical analyses were performed, including descriptive statistics, multivariate logistic regression and survival analysis;Results: An association between tumor size (pT,p< 0.001), grading (p= 0.013), budding (p< 0.001), LVI (79,4%p< 0.001) and LNM was observed. A multivariate analysis identified pT4 (OR 5.45,p< 0.001) and LVI+ (OR 10.7,p< 0.001) as significant predictors of LNM. Right-sided patients presented a worse OS when associated with LNM, while no significant difference was observed in N0 patients;Conclusions: histological and molecular analysis can help identify high risk patients, which could benefit from extended lymphadenectomies. These patients could be ideal candidates for the D3 lymphadenectomy/CME.
背景：淋巴结清扫术在局限性结肠癌治疗中占据核心地位。虽然左半结肠癌中D3淋巴结清扫术/完整结肠系膜切除术已被视为标准治疗方案，但右半结肠癌需清扫的淋巴区域仍存在争议。明确淋巴结转移风险因素有助于指导右半结肠癌淋巴结清扫范围。本研究旨在分析左右半结肠癌中组织病理学及分子特征与淋巴结转移的相关性及其对生存预后的影响。 方法：我们开展了一项单中心观察性回顾研究。收集并分析每位患者的以下数据：人口统计学特征、组织病理学与分子生物学数据、术中及围手术期资料。采用描述性统计、多因素逻辑回归及生存分析等统计方法。 结果：研究发现肿瘤大小（pT分期，p<0.001）、分化程度（p=0.013）、出芽现象（p<0.001）及淋巴血管侵犯（79.4%，p<0.001）与淋巴结转移显著相关。多因素分析确定pT4分期（OR 5.45，p<0.001）和淋巴血管侵犯阳性（OR 10.7，p<0.001）是淋巴结转移的独立预测因子。右半结肠癌患者若伴有淋巴结转移则总生存期更差，而N0期患者未见显著差异。 结论：组织学与分子生物学分析有助于识别高危患者群体，此类患者可能从扩大淋巴结清扫术中获益，是实施D3淋巴结清扫术/完整结肠系膜切除术的理想候选对象。
肿瘤(癌症)患者之家