RT Journal Article
SR Electronic
T1 Prognostic Utility of Apical Lymph Node Metastasis in Patients With Left-sided Colorectal Cancer
JF In Vivo
JO In Vivo
FD International Institute of Anticancer Research
SP 2981
OP 2989
DO 10.21873/invivo.12129
VO 34
IS 5
A1 LIMING WANG
A1 YASUMITSU HIRANO
A1 GREGORY HENG
A1 TOSHIMASA ISHII
A1 HIROKA KONDO
A1 KIYOKA HARA
A1 NAO OBARA
A1 MASAHIRO ASARI
A1 SHIGEKI YAMAGUCHI
YR 2020
UL http://iv.iiarjournals.org/content/34/5/2981.abstract
AB Background: Unlike the tumor nodes metastasis (TNM) lymph node classification, based solely on counts of nodal metastases, the Japanese system of classifying colorectal carcinoma (CRC) focuses on regional lymph node spread. In this study, we explored the prognostic utility of inferior mesenteric artery (IMA) apical lymph node (APN) metastasis. Patients and Methods: This was a retrospective study of patients with stage III left-sided CRC. All enrollees were subjected to D3 resection between April 2007 and December 2016 at the International Medical Center of Saitama Medical University and then stratified by histologic presence (APN+ group) or absence (APN− group) of tumor in APNs examined postoperatively. Ultimately, propensity score matching was invoked (1:2) and COX regression analysis was conducted, determining group rates of relapse-free survival (RFS) and cancer-specific survival (CSS). Results: A total of 498 patients were studied, grouped as APN+ (19/498, 3.8%) or APN− (479/498, 96.2%). Prior to matching, the APN+ (vs. APN−) group showed significantly more lymphatic involvement (73.7% vs. 47.8%; p=0.023), deep (T3/T4) tumor infiltration (100% vs. 78.9%; p=0.024), and nodal metastasis (N2: 84.2% vs. 27.6%; p<0.001). In addition, para-aortic nodal recurrences were significantly increased (15.7% vs. 2.0%; p<0.001), conferring worse RFS (p<0.001) and CSS (p=0.014) rates. Once baseline factors were matched, the two groups appeared similar in RFS (p=0.415) and CSS (p=0.649). Multivariate regression analysis indicated that elevated carcinoembryonic antigen (CEA) level and deep tumor infiltration were independent risk factors for RFS, whereas postoperative complications and tumor-positive node counts were independent risk factors for CSS. APN+ status was not a significant risk factor for RFS or CSS. Conclusion: APN positivity may thus constitute a regional rather than systemic manifestation. The TNM staging based on the number of metastatic lymph nodes seems to be more reasonable than the regional lymph node classification method.