SIMULTANEOUS VS STAGED RESECTIONS IN COLON CANCER PATIENTS WITH SYNCHRONOUS LIVER METASTASES: PROGNOSTIC IMPACT OF LYMPH NODE RATIO AND TUMOR BURDEN SCORE
DOI:
https://doi.org/10.15407/exp-oncology.2025.03.347Keywords:
colon cancer, synchronous liver metastases, lymph node ratio, tumor burden score, staged and simultaneous resectionsAbstract
Background. Synchronous metastatic liver disease (SLM) in colon cancer (CC) patients is an extremely unfavorable prognostic factor. The impact of lymph node ratio (LNR) and tumor burden score (TBS) on prognosis in this subset of patients remains incompletely understood. Aim. To assess the impact of LNR and TBS on survival in CC patients with synchronous LM who underwent staged or simultaneous surgery. Materials and Methods. A retrospective analysis of 365 patients with CC and SLM who underwent either staged or simultaneous surgical resection at the National Cancer Institute (Kyiv, Ukraine) between 2010 and 2024 was conducted. The demographic, clinicopathological, and survival data were analyzed. LNR was defined as the proportion of metastatic lymph nodes to total harvested lymph nodes, with a cutoff of 0.25. TBS was calculated using the Sasaki formula and categorized into three risk groups. Results. A mathematical model identified TBS clusters (p < 0.04, HR = 1.8, 95% CI 1.1—2.3), the number of LM (p = 0.02, HR = 0.8, 95% CI 0.3—1.4), pN stage (p = 0.03, HR = 0.6, 95% CI 0.3—0.9), LNR (p = 0.005, HR = 3.1, 95% CI 2.2—4.2), and KRAS gene status (p = 0.01, HR = 1.1, 95% CI 1.1—1.3) as independent risk factors for overall survival. Conclusion. Lymph node ratio and tumor burden score allow us to argue the surgical strategy choice for CC patients with synchronous liver metastases who are candidates for surgical resection. The staged surgical strategy provided better oncological outcomes in CC patients with both high LNR and TBS.
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