Abstract
BackgroundApproximately 20% of patients with colorectal cancer are initially diagnosed with stage IV disease. This study aims to examine the role of regional lymph node (LN) status in metastatic colorectal cancer (mCRC) with respect to clinicopathologic features and survival outcomes.MethodsWe investigated 1147 patients diagnosed with mCRC and had undergone surgical resection of the primary CRC. A total of 167 patients were placed in the LN-negative (LN−) group and another 980 in the LN-positive (LN+) group.ResultsLN+ patients exhibited a significantly higher rate of T4 tumors (p = 0.008), poorly differentiated adenocarcinoma (p < 0.001), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001) than those in the LN− group. LN− patients had a significantly higher rate of lung metastasis (p < 0.001), whereas the rate of peritoneal seeding (p < 0.001) and systemic node metastasis (p < 0.001) was both significantly higher in the LN+ group. The 5-year overall survival (OS) in the LN+ group was significantly poorer than that in the LN− group (LN− vs. LN+ 23.2% vs. 18.1%; p = 0.040). In patients with curative resection, the 5-year OS rate has no significant difference between the two groups (LN− vs. LN+ 19.5% vs. 24.3%; p = 0.890).ConclusionsMetastatic CRC patients with LN+ who underwent primary tumor resection may present with more high-risk pathological features, more peritoneal seeding, and systemic node metastasis, but less lung metastasis than LN− patients. LN+ patients had poorer long-term outcomes compared with that in LN− patients. Nevertheless, with curative resection, LN+ patients could have similar survival outcomes as LN− patients.
Highlights
20% of newly diagnosed colorectal cancer patients present with synchronous distant metastasis, the majority of whom are only eligible for treatment with palliative intent, and the prognosis in these patients isKuo et al World Journal of Surgical Oncology (2021) 19:150 with chemotherapy alone [19, 20]
We examined the role of regional lymph node (LN) status in patients with metastatic colorectal cancer (mCRC) concerning clinicopathologic features, metastatic sites, and survival outcomes
Patients whose pathologic reports indicated no regional LN metastasis were classified as the lymph node-negative (LN−) group, whereas those with any positive regional LN were classified as the lymph nodepositive (LN+) group
Summary
20% of newly diagnosed colorectal cancer patients present with synchronous distant metastasis, the majority of whom are only eligible for treatment with palliative intent, and the prognosis in these patients isKuo et al World Journal of Surgical Oncology (2021) 19:150 with chemotherapy alone [19, 20]. 20% of newly diagnosed colorectal cancer patients present with synchronous distant metastasis, the majority of whom are only eligible for treatment with palliative intent, and the prognosis in these patients is. The mechanisms and routes of metastasis in CRC are poorly understood, and the prognostic factors can only be surmised from demographic data and epidemiologic reports. Around 18% of patients with mCRC did not present regional LN involvement [23, 24]. A newly developed mouse model of CRC has demonstrated that liver metastases can develop without prior LN involvement [25]. This study aims to examine the role of regional lymph node (LN) status in metastatic colorectal cancer (mCRC) with respect to clinicopathologic features and survival outcomes
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