Prognostic impact of lymph node skip metastasis in Stage III colorectal cancer. (September 2016)

• Record Type: Journal Article
• Authors: Bao, F.; Zhao, L.‐y.; Balde, A. I.; Liu, H.; Yan, J.; Li, T.‐t.; Chen, H.; Li, G.‐x.
• Is Part Of: Colorectal disease. Volume 18:Number 9(2016)
• Page Start: O322
• Page End: O329
• Publication Date: 2016-09
• Subjects: Colorectal cancer -- lymph node -- skip metastasis -- prognosis; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13465
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: The aim of this study was to evaluate the prognostic impact of lymph node skip metastasis (LNSM) in patients with Stage III colorectal cancer. Method: Between April 2003 and December 2014, a total of 41 patients with lymph node skip metastasis (skip+) were compared with 86 patients with pericolic lymph node metastases [lymph node distribution (LND)1] and 57 patients with intermediate and/or main lymph node metastasis (LND2+3). All patients had radical D3 lymphadenectomy, performed either laparoscopically or as open surgery. Results: The frequency of pT1–2 stage cancer was significantly higher in the skip+ group than in the LND1 group (26.8% vs 5.8%, P = 0.001). The number of metastatic lymph nodes in the skip+ group was lower than in the LND2+3 group (1.9 ± 1.5 vs 6.5 ± 6.0, P < 0.001). The 3‐year disease‐free survival (DFS) of the skip+, LND1 and LND2+3 groups was 64.8%, 69.7% and 40.1%, respectively ( P = 0.008). The 3‐year systemic recurrence rates of the skip+, LND1 and LND2+3 groups were 30.2%, 20.3% and 48.1%, respectively; ( P = 0.002). Cox regression analysis revealed that preoperative carcinoembryonic antigen (CEA) of ≥ 5 ng/ml [hazard ratio (HR) = 2.2, P = 0.029], poor differentiation (HR = 3.8, P = 0.001) and skip+ (HR = 0.2, P = 0.021) were independently prognostic factors for DFS. Conclusion: The prognosis for the LND1‐negative lymph node skip metastasis group was better than for the LND2+3 group and was comparable with that of the LND1 group after radical D3 lymphadenectomy.