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International Session (Symposium)7 (JSGS・JSGE)
Sat. October 14th   9:40 - 12:00   Room 6: Fukuoka International Congress Center 203+204
Clinical significance of lateral lymph node dissection for rectal cancer with respect to tumor staging
Y. Hashiguchi1, T. Tsuchiya1, K. Sugihara2
1Department of Surgery, Teikyo University, 2Tokyo Medical and Dental University
BACKGROUND: After JCOG0212 trial, more patients may undergo lateral lymph node dissection (LLND) outside Japan. LLN involvement (LLN(+) ) should be properly implemented to the TNM. AIM: to clarify the significance of LLND with respect to tumor staging. METHODS: We analyzed the cohort data from 22 institutions of the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. A total of 1,197 patients who had undergone potentially curative resection with LLND for rectal cancer between 1997 and 2006 were eligible. The mTNM-A staging system is with slight modification, if main LNs are positive (Main (+) ) or LLN(+), the N-category was defined as N2b regardless of the number of LNs involved (NLNI). In the mTNM-B staging system, N2c is further added and defined as NLNI >6 together with Main(+) or LLN(+). The TNM, mTNM-A, and mTNM-B staging systems were compared based on the AIC, and C-index with respect to relapse-free survival (RFS). RESULTS: The 5-year RFS for patients in TNM N2a and N2b were 55.7 and 36.9%, while mTNM-B N2a, N2b, and N2c were 58.0, 44.8, and 15.3%, respectively. The AIC for TNM, mTNM-A, and mTNM-B staging systems for Stage III patients are 3361, 3344, and 3335, while C-index are 0.633, 0.647, 0.658, respectively (p<0.05). CONCLUSIONS: Patients who underwent LLND were significantly better staged by the use of modified N category.
Index Term 1: LLND
Index Term 2: TNM
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