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Middle East Journal of Cancer MEJC is an international peer-reviewed journal which aims to publish high-quality basic science and clinical research in the field of cancer.


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This journal will also reflect the current status of research as well as diagnostic and treatment practices in the field of cancer in the Middle East, where cancer is becoming a growing health problem. Lastly, MEJC would like to become a model for regional journals with an international outlook. Accordingly, manuscripts from authors anywhere in the world will be considered for publication. MEJC is freely available for readers and researchers and we have no publication or processing fee. All articles starting from , will be included in this index. Publisher: Shiraz University of Medical Sciences.

Middle East Journal of Cancer

Abdolrasoul Talei. Farhad Handjani. Ahmad Monabati. Heba El-Sheredy; Sanaa A. Articles in Press. Volume 10 Issue 4. Issue 3. Issue 2. Patients who met the following criteria were enrolled: 1 underwent curative or palliative primary tumor resection with regional LN yield; the surgeries were either elective or emergency surgeries; 2 comprehensive assessment and multidisciplinary review were performed before the operation; 3 available records of routine blood tests before any treatment; 4 available paraffin-embedded tissue blocks; and 5 available follow-up information.

Curative resection was defined as the complete resection of a macroscopic tumor R0 resection with negative pathological margins and no evidence of metastases [ 13 ]. Patients with rectal cancers, multiple colon cancers, hereditary colorectal cancer, inflammatory bowel disease, and second primary tumors as well as those who underwent an enterostomy were excluded from the study.

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Data on patient demographics, tumor characteristics, laboratory test results, and intact therapeutic procedures were obtained from our electronic medical records. The histopathology of the primary tumor, LN metastatic status, and perineural or vascular invasion status were confirmed by the Department of Pathology.


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Survival data were collected by telephone interview or review of medical records. The last follow-up was performed on September 30, Due to the lack of a uniform cutoff value, the median value of the LNR is generally accepted as the critical value [ 15 , 16 ].

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In our data, a cutoff of 0. OS was defined as the time from diagnosis to death for any reason or the last follow-up. The distributions of the patient characteristics were assessed by the Chi square test. OS was estimated by the Kaplan-Meier method, and survival differences were analyzed by the log-rank test. Multivariate analyses and a Cox proportional hazards model were used to determine the independent prognostic factors for OS.

SPSS version Written informed consent was gathered from each patient. A total of patients were enrolled in this retrospective study. Their baseline clinicopathologic features are shown in Table 1. The median age at diagnosis was 58 years range, years , and Most patients The primary lesion of patients Only The liver was the most frequent organ for metastasis; other metastatic sites included the peritoneal and pelvic cavities, lungs, stomach, small intestine, ovaries, and LNs at multiple sites.

A total of 81 The median count of the retrieved LNs was 11 range, , and the median number of metastatic LNs was 2 range, The median LNR was 0. Table 1 shows a comparison of the patients' characteristics between the two groups. Overall survival according to lymph node status and serum carbohydrate antigen 19 -9 levels in all patients.

Subgroup analyses by resection group are shown in Table 3. The LNR was the only prognostic factor in the curative resection group.


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  7. Univariate and multivariate Cox proportional hazards models were used to determine the independent prognostic factors for OS Table 4. Kaplan-Meier estimates of overall survival. Overall survival was assessed in the total population according to the initial total lymph node yield A , the number of negative lymph nodes B , the metastatic lymph node ratio C , and carbohydrate antigen levels D.

    Kaplan-Meier estimates of overall survival in the curative resection group. Overall survival was assessed in the curative resection group according to the initial total lymph node yield A , the number of negative lymph nodes B , the metastatic lymph node ratio C , and carbohydrate antigen levels D. Overall survival according to lymph node status and serum carbohydrate antigen levels by type of resection. Univariate and multivariate analyses of the factors affecting overall survival by Cox proportional hazard model. Kaplan-Meier estimates of overall survival in the palliative resection group.

    Overall survival was assessed in the palliative resection group according to the initial total lymph node yield A , the number of negative lymph nodes B , the metastatic lymph node ratio C , and carbohydrate antigen levels D.

    Journal of Cancer Metastasis and Treatment

    In the present study, we found the LNR can be used as an independent prognostic factor in patients with stage IV colon cancer who underwent curative or palliative resection of the primary tumor. Considering the heterogeneity of colon cancer, it is easy to understand that patients with a lower CA level, fewer metastases at multiple sites, and a less advanced tumor infiltration status were more likely to have a longer OS.

    Surgical removal of the primary tumor has been reported to improve the outcomes of potentially curable patients with colorectal cancer [ 17 , 18 ]. The benefit of palliative resection in patients with unresectable metastases remains controversial. With the development of systemic chemotherapy and the treatment of local lesions, the benefit of palliative resection of the primary tumor in specific patient populations has been gradually recognized [ 19 , 20 ]. The prognostic factors of resectable metastatic colon cancer, such as the CEA level, tumor differentiation, and perineural invasion, have been extensively researched [ 17 , 18 , 21 ].

    In this study, we found that the initial CA level was associated with OS in patients with resectable stage IV colon cancer. This is consistent with our identification of CA as an independent prognostic biomarker in patients with metastatic colorectal cancer [ 22 ]. The lymph nodes status is critical for prognosis in non-stage IV colon cancer in the current TNM staging system. Several studies have identified the LNR as a significant prognostic factor in patients with stage III colon cancer [ 23 - 25 ]; the LNR was a better prognostic factor that the positive LN count [ 16 ].

    In stage IV colon cancer, researchers have suggested the prognostic significance of the LNR in patients with potentially curable disease [ 14 , 26 - 28 ]. In patients with unresectable metastases, Ishihara et al. Zhang et al reported more accuracy of survival prediction through the incorporation of negative LN into American Joint Committee on Cancer stages [ 29 ]. In our study, we further explored the role of the LNR in patients undergoing palliative resection. We identified the LNR as a in dependent negative predictor of prognosis in patients with metastatic colon cancer, specifically in those with unresectable metastases.

    A low LNR high quota, rather than the number of retrieved LNs could be interpreted as a strong anti-tumor immune response [ 30 , 31 ]. The main limitations of this study are its retrospective study design and the relatively small number of patients with curative resection. In conclusion, the LNR and initial CA levels were independently associated with OS in patients with metastatic colon cancer patients who underwent curative or palliative resection.

    Our data suggest that the LNR can serve as a prognostic indicator in patients with stage IV colon cancer and can be used to establish an adequate treatment strategy.

    Materials and Methods

    Further validation studies are needed. Global cancer statistics, Ca A Cancer Journal for Clinicians. Outcome and natural history of patients with stage IV colorectal cancer receiving chemotherapy without primary tumor resection. Ann Surg Oncol. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. The outcome after stent placement or surgery as the initial treatment for obstructive primary tumor in patients with stage IV colon cancer.

    Am J Surg. European Journal of Surgical Oncology.