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Purpose <p>To evaluate the impact of D3 lymph node dissection and nutritional status on outcomes in patients aged ≥80&#xa0;years with colorectal cancer.</p> Methods <p>We retrospectively analyzed patients aged ≥80&#xa0;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.</p> Results <p>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%, <i>P</i> = 0.0039) and DFS (5-year: 69.5% vs. 56.1%, <i>P</i> = 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%, <i>P</i> = 0.024). Multivariate analysis identified D3 dissection and PNI ≥ 45 as independent favorable prognostic factors for OS, DFS, and CSS.</p> Conclusions <p>In patients aged ≥80&#xa0;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.</p>

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Prognostic value of D3 lymph node dissection and nutritional status in colorectal cancer patients aged 80 years and older

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月25日

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  • Yasuhiro Ishiyama,
  • Yasumitsu Hirano,
  • Sohei Akuta,
  • Yume Minagawa,
  • Akihito Nakanishi,
  • Yusuke Nishi,
  • Hisashi Hayashi,
  • Takatsugu Fujii,
  • Hirofumi Sugita,
  • Chikashi Hiranuma

摘要

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.