Abstract
The effect of apical lymph node (APN) metastasis on the prognosis of colon cancer is unknown. The present study investigated the impact of APN metastasis on the prognosis of the patients with high-risk stage III colon cancer. This retrospective multi-institutional study included patients with pathological high-risk stage III colon cancer who underwent surgery between April 2009 and December 2014. Clinicopathological factors were examined by univariate and multivariate analyses to clarify independent risk factors for overall survival (OS) and relapse-free survival (RFS). A total of 185 patients were collected. The 5-year OS rates of patients with and without APN metastasis were 35.0% and 72.1%, respectively (p = 0.0014). The 5-year RFS rates of patients with and without APN metastasis was 16.2% and 57.2%, respectively (p = 0.0002). The rate of distant metastasis in patients with APN metastasis was significantly higher than that in patients without APN metastasis (68.8% vs. 36.7%, p = 0.012). The univariate analysis revealed that the differentiation, lymph node ratio, and APN metastasis were significantly associated with 5-year OS, and the preoperative CEA and CA19-9 levels and APN metastasis were significantly associated with 5-year RFS. The multivariate analysis showed that APN metastasis was an independent risk factor for 5-year OS and RFS. APN metastasis may be independently associated with the prognosis of patients with high-risk Stage III colon cancer.
Highlights
Lymph node metastasis in colon cancer is an important indicator of the need for postoperative adjuvant chemotherapy[1] and accurate classification is needed to predict the prognosis of such patients
Suzuki et al showed that the number of metastatic lymph nodes predicted the prognosis better than the distribution of metastatic lymph nodes in patients with stage III colon c ancer[12], and some authors have shown no marked difference in the survival of patients with stage N2 disease and those with apical lymph node (APN) metastasis[17,18]
Huh et al proposed the concept that the metastatic lymph node distribution is an independent prognostic factor for both overall survival (OS) and disease-free survival in patients with sigmoid colon and rectal c ancer[6]
Summary
Lymph node metastasis in colon cancer is an important indicator of the need for postoperative adjuvant chemotherapy[1] and accurate classification is needed to predict the prognosis of such patients. The American Joint Committee on Cancer (AJCC) staging system and the Union for International Cancer Control (UICC) TNM classification 8th edition recommend the collection of at least 12 lymph nodes for an accurate diagnosis, and lymph node metastasis is categorized completely by number, rather than by location. This classification is simple and easy to understand and has been widely accepted around the world. The present study investigated the influence of APN metastasis on the prognosis of patients with high-risk stage III colon cancer
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