Jong Wan Kim

Background: The prognostic nutritional index (PNI), derived from serum albumin levels and lymphocyte counts, reflects both nutritional and immunologic status. This study aimed to evaluate the association between preoperative PNI and long‐term oncologic outcomes and postoperative complications in patients undergoing curative resection for colorectal cancer (CRC). Methods: A multicenter retrospective analysis was conducted on 3045 patients with stage I–III CRC who underwent curative surgery at five Hallym University‐affiliated hospitals between 2012 and 2023. Preoperative PNI, lymphocyte‐to‐monocyte ratio (LMR), neutrophil‐to‐lymphocyte ratio (NLR), and platelet‐to‐lymphocyte ratio (PLR) were calculated using laboratory values within 2 weeks prior to surgery. The optimal PNI cutoff for overall survival (OS) was determined by receiver operating characteristic analysis. Results: The optimal preoperative PNI cutoff was 43.4 (area under the curve = 0.643, sensitivity = 60.4%, specificity = 59.4%). Patients with low PNI (< 43.4) exhibited significantly poorer 5‐year OS (59.0% vs. 80.0%, p < 0.001) and recurrence‐free survival (RFS) (51.4% vs. 73.2%, p < 0.001) compared to the high PNI group. These associations remained consistent across all cancer stages. In multivariate analysis, low PNI was independently associated with OS (hazard ratio [HR] = 1.535, p < 0.001) and RFS (HR = 1.519, p < 0.001), as well as increased risk of severe complications (odds ratio = 2.503, p < 0.001). PNI showed better predictive performance than LMR, NLR, and PLR for these outcomes. Conclusions: Preoperative PNI is an independent predictor of oncologic outcomes and perioperative risk in CRC patients and may serve as a practical biomarker for preoperative risk stratification.

Purpose: The objective of this retrospective multicenter study was to evaluate the efficacy of adjuvant chemotherapy (adCTx) following curative resection in patients aged ≥ 70 years with colorectal cancer (CRC) and to compare the outcomes of monotherapy versus combination chemotherapy. Methods: Data from 1183 patients with stage II or III CRC who underwent surgery at five Hallym University-affiliated hospitals in Korea between 2012 and 2022 were retrospectively analyzed. Patients were divided into two groups based on adjuvant chemotherapy status (adCTx (+) vs adCTx (-)). Those receiving adCTx were further stratified into 5-fluorouracil (5-FU) monotherapy or 5-FU plus oxaliplatin combination therapy. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) for overall survival (OS) and recurrence-free survival (RFS). Results: Of the 1183 patients, 555 received adCTx and 628 did not. Patients in the adCTx (+) group showed significantly better 5-year OS (88.6% vs 75.7%, P < 0.001) and RFS (66.5% vs 58.6%, P < 0.001). In multivariable analysis, adCTx was independently associated with improved OS (HR 0.33, 95% CI 0.23– 0.48, P < 0.001) and RFS (HR 0.59, 95% CI 0.47– 0.76, P < 0.001). Among patients receiving chemotherapy, there was no significant difference in OS or RFS between monotherapy and combination therapy. In stage II patients with high-risk factors, adCTx (+) was associated with better OS (P = 0.002) and RFS (P = 0.006), but the number of agents did not provide additional benefit. Conclusion: In this study of patients aged ≥ 70 years with stage II or III CRC, adjuvant chemotherapy was associated with improved OS and RFS. No significant differences in oncologic outcomes were observed between monotherapy and combination therapy. These findings suggest a potential benefit of adjuvant chemotherapy in selected elderly patients; however, prospective randomized studies are needed to confirm these results.

Purpose: The COVID-19 pandemic has influenced various aspects of colorectal cancer (CRC) patient care, including diagnosis, treatment, and outcomes. This study assesses the pandemic’s impact on CRC patients. Methods: We performed a retrospective analysis of medical records for CRC patients who underwent surgery at five hospitals affiliated with Hallym University from January 2017 to December 2022. Patients were divided into two groups: the pre-COVID group (2017– 2019) and the COVID group (2020– 2022). Results: Among 2038 patients, 987 (48.4%) were in the pre-COVID group, and 1051 (51.6%) were in the COVID group. The COVID group had more patients with two or more comorbidities (P < 0.001) and a higher incidence of rectal cancer (P = 0.010). While the rates of laparoscopic surgeries were similar, the COVID group had increased emergency surgeries (P = 0.005) and diversion procedures (P = 0.002). Additionally, the COVID group faced more overall complications (P < 0.001) and severe complications (Grade III–V, P = 0.004). There was a rise in lymphovascular invasion (P < 0.001) and T4 stage tumors (P < 0.001) within the COVID group. Despite these differences, both groups had similar 2-year overall survival rates (P = 0.409). Conclusion: Although patients treated during the COVID period experienced more frequent stoma formation, complications, and adverse prognostic factors, there were no differences in short-term oncologic outcomes, which was likely due to the follow-up period being insufficient to detect differences in OS.

Background. The objective of this study was to compare the long-term prognosis of patients with T1 and T2 colorectal cancer (CRC) according to lymph node metastasis (LNM) and to identify risk factors for LNM. Methods. We retrospectively reviewed patients who underwent curative resection for T1 or T2 CRC at five University-affiliated hospitals between January 2012 and December 2021. The patients were divided into several groups depending on the presence of LNM or the number of risk factors. Results. Of the total 765 patients, 87 (11.3%) patients had LNM. These patients had poorer recurrence-free survival (RFS) than patients without LNM (72.6% vs. 88.6%). The multivariable analysis showed that high-grade tumors (p = 0.003), lymphovascular invasion (p < 0.001), and rectal location (p = 0.049) were independent predictors of LNM. When divided into groups according to the number of the three risk factors, the risk of LNM increased from 5.4% (ultralow-risk group; no risk factor) to 60.0% (high-risk group; all three risk factors) and the 5-year RFS rate decreased from 96.3% in the ultralow-risk group to 60% in the high-risk group (p < 0.001). Conclusion. Radical surgery should be considered for T1 and T2 CRC patients with these risk factors.

Oncologic impact of genetic alteration across synchronous colorectal cancer (CRC) still remains unclear. This study aimed to compare the oncologic relevance according to genetic alteration between synchronous and solitary CRC with performing systematic review. Multicenter retrospective analysis was performed for CRC patients with curative resection. Genetic profiling was consisted of microsatellite instability (MSI) testing, RAS (K-ras, and N-ras), and BRAF (v-Raf murine sarcoma viral oncogene homolog B1) V600E mutation. Multivariate analyses were conducted using logistic regression for synchronicity, and Cox proportional hazard model with stage-adjusting for overall survival (OS) and disease-free survival (DFS). It was identified synchronous (n = 36) and solitary (n = 579) CRC with similar base line characteristics. RAS mutation was associated to synchronous CRC with no relations of MSI and BRAF. During median follow up of 77.8 month, Kaplan–meier curves showed significant differences according to MSI-high for OS, and in RAS, and BRAF mutation for DFS, respectively. In multivariable analyses, RAS and BRAF mutation were independent factors (RAS, HR = 1.808, 95% CI = 1.18–2.77, p = 0.007; BRAF, HR = 2.417, 95% CI = 1.32–4.41, p = 0.004). Old age was independent factor for OS (HR = 3.626, 95% CI = 1.09–12.00, p = 0.035). This study showed that oncologic outcomes might differ according to mutation burden characterized by RAS, BRAF, and MSI between synchronous CRC and solitary CRC. In addition, our systematic review highlighted a lack of data and much heterogeneity in genetic characteristics and survival outcomes of synchronous CRC relative to that of solitary CRC.

Background: The objective of this study was to evaluate clinicopathologic features of young patients with colorectal cancer (CRC) and to compare their prognosis with those of older patients Methods: We retrospectively reviewed the medical records of patients who underwent surgery for stage 0–III CRC at four university-affiliated hospitals between January 2011 and December 2020. The patients were divided into two groups, the young adult group (≤45 years) and the older group (>45 years). Results: Of 1992 patients, 93 (4.6%) were young adults and 1899 (95.3%) were older patients. Young patients showed more symptoms (p = 0.014) and more poorly or undifferentiated adenocarcinoma (p = 0.047) than older patients. The young adult patients were more likely to receive adjuvant chemotherapy (p < 0.001) and multidrug agents (p = 0.029), and less likely to cease chemotherapy (p = 0.037). The five-year RFS (recurrence-free survival) rate was better in the young adults than in the older patients (p = 0.009). In the multivariable analysis, young age was a significant prognostic factor for better RFS (p = 0.015). Conclusions: Young patients with CRC had more symptoms, aggressive histological features than older patients. They received more multidrug agents and discontinued chemotherapy less often, resulting in better prognosis.

Background Oncologic impact of genetic alteration across synchronous colorectal cancer (CRC) still remains unclear. This study aimed to compare the oncologic relevance according to genetic alteration between synchronous and solitary CRC with performing systematic review. Methods Multicenter retrospective analysis was performed for CRC patients with curative resection. Genetic profiling was consisted of microsatellite instability (MSI) testing, RAS (K-ras, and N-ras), and BRAF (v-Raf murine sarcoma viral oncogene homolog B1) V600E mutation. Multivariate analyses were conducted using logistic regression for synchronicity,and Cox proportional hazard model with stage-adjusting for overall survival (OS) and disease-free survival (DFS). Results It was identified synchronous (n = 36) and solitary (n = 579) CRC with similar base line characteristics. RAS mutation was associated to synchronous CRC with no relations of MSI and BRAF. During median follow up of 77.8 month, Kaplan-meier curves showed significant differences according to MSI-high for OS, and in RAS, and BRAF mutation for DFS, respectively. In multivariable analyses, RAS and BRAFmutation were independent factors (RAS, HR = 1.808, 95% CI = 1.18–2.77, p = 0.007; BRAF, HR = 2.417, 95% CI = 1.32–4.41, p = 0.004). Old age was independent factor for OS (HR = 3.626, 95% CI = 1.09–12.00, p = 0.035). Conclusion This study showed that oncologic outcomes might differ according to mutation burden characterized by RAS, BRAF, and MSI between synchronous CRC and solitary CRC. In addition, our systematic review highlighted a lack of data and much heterogeneity in genetic characteristics and survival outcomes of synchronous CRC relative to that of solitary CRC.

The insertion of a self-expandable metal stent (SEMS) has been proposed as an alternative to emergent surgery (ES) for obstructive colorectal cancer (CRC). We aimed to evaluate the perioperative and oncologic outcomes of SEMS as a bridge to surgery in obstructive CRC, as compared with ES. We retrospectively reviewed the medical records of patients who underwent curative resection of obstructive CRC at four Hallym University-affiliated hospitals between January 2010 and December 2019. All patients were analyzed overall colon, then according to the side of obstruction (overall, right or left). Of 167 patients, 52 patients underwent ES and 115 underwent SEMS insertion and surgery (SEMS group). The postoperative hospital stay and time to soft diet were shorter in the SEMS group than in the ES group for overall and both sided cancer. The SEMS group had lower rates of stoma formation and severe complications for overall and for left-sided cancer. The 5-year overall survival (P = 0.682) and disease-free survival (P = 0.233) rates were similar in both groups. SEMS insertion as a bridge to surgery was associated with faster recovery, a lower rate of stoma formation with similar oncologic outcomes to those of ES.

Lim SH, et al. Ann Surg Treat Res. 2023 Oct;105(4):237-244. https://doi.org/10.4174/astr.2023.105.4.237