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KMID : 0371420180950040201
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Annals of Surgical Treatment and Research
2018 Volume.95 No. 4 p.201 ~ p.212
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Significance of lymph node metastasis in the survival of stage IV colorectal cancer by hematogenous metastasis
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Han Eon-Chul
Kwon Yoon-Hye
Park Kyu-Joo
Jeong Seung-Yong
Kang Sung-Bum
Oh Jae-Hwan
Heo Seung-Chul
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Abstract
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Purpose: Although lymph node (LN) metastasis is an important prognostic marker of colorectal cancer (CRC), the effect of LN metastasis on the survival of stage IV CRC is debated yet.
Methods: LN status and survivals as well as clinicopathological features of synchronous stage IV CRC patients, operated for 8 years, were analyzed. Patients with hematogenous metastases were included only but those with peritoneal seeding or preoperative adjuvant therapy were not included.
Results: Total 850 patients were enrolled and 77 (9.1%) were without LN metastases (N0M1). N0M1 patients were older and have favorable pathological features including lower CEA than patients with LN metastasis (N + M1). The pathologically poor features accumulated with N stage progression within N + M1. N0M1 had better 5-year overall survival (OS) and disease free survival than N + M1. And 5-year OS's within N + M1 group were stratified and different according to N stage progression, although the effect of N stage progression is different according to curative resection or not. When compared with stage III, 5-year OS of N0M1 with curative resection was comparable to that of anyTN2aM0 and was better than anyTN2bM1.
Conclusion: LN metastasis is a significant prognostic factor in stage IV by hematogenous metastasis, too. N stage progression accumulates pathologically poor prognostic factors. However, the effect on survival of each N stage progression differs depending on curative resection or not of the hematogenous metastases.
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KEYWORD
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Colorectal neoplsms, Neoplasm metastasis, TNM classification
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