Abstract
The prognostic significance of apical lymph node metastasis in colorectal cancer has been widely debated in the past. Current AJCC staging guidelines do not explicitly take this pathological variable into account but most structured reporting schemes recommend that the apical lymph node status be determined and recorded. We sought to investigate the prognostic significance of apical lymph node metastasis in colorectal carcinomas undergoing surgery with curative intent. The data from 1,374 patients used in this analysis was collected during a period of six years (2004–2009) at a large Australian tertiary hospital. For each patient where survival data was available, histopathology reports relevant to the patient's curative resection were obtained and reviewed for apical node status information. Survival analysis was performed using Kaplan-Meier method and the relationship between apical node status and total nodal involvement examined using the Mann-Whitney U test. On univariate analysis, overall survival was significantly lower in patients with apical node metastasis (mean survival: 2.4 years) compared with patients without apical node involvement (median survival: 8.3 years). After controlling for pathological stage, significantly lower survival was only observed in selected apical node positive patient groups with higher stage disease – stages 3C and 4B. A positive relationship was also observed between the total number of involved nodes and the likelihood of apical node metastasis.
Published Version
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