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Published on: September 27, 2024
Prognostic value of D3 lymph node dissection and nutritional status in colorectal cancer patients aged 80 years and
Yasuhiro Ishiyama1, Yasumitsu Hirano2, Sohei Akuta2
1Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan. yishiyama1215@saitama-med.ac.jp.
Purpose:
To evaluate the impact of D3 lymph node dissection and nutritional status on outcomes in patients aged ≥80 years with colorectal cancer.
Methods:
We retrospectively analyzed patients aged ≥80 years who underwent curative resection for stage I-III colorectal cancer between April 2007 and February 2020. Patients were divided into D3 and non-D3 lymph node dissection groups. Propensity score matching was performed to reduce baseline differences. Short- and long-term outcomes, including overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS), were compared. Multivariate Cox regression analyses were used to identify independent prognostic factors, with particular attention to the prognostic nutritional index (PNI). Competing-risk analysis for cancer-specific death was also conducted.
Results:
After propensity score matching, 272 patients (136 per group) were analyzed. The D3 group showed significantly better OS (5-year: 73.5% vs. 60.0%, P = 0.0039) and DFS (5-year: 69.5% vs. 56.1%, P = 0.0099) than the non-D3 group. CSS was not significantly different on Kaplan-Meier analysis; however, competing-risk analysis demonstrated a significantly lower cumulative incidence of cancer-specific death in the D3 group (5-year: 23.0% vs. 29.6%, P = 0.024). Multivariate analysis identified D3 dissection and PNI ≥ 45 as independent favorable prognostic factors for OS, DFS, and CSS.
Conclusions:
In patients aged ≥80 years with colorectal cancer, D3 lymph node dissection improved OS and DFS without increasing perioperative morbidity. Preoperative PNI was a strong predictor of long-term prognosis and may aid surgical decision-making in elderly patients.
