Pattern of Recurrences and Metastases according to Regional Lymph Node Metastasis of Colorectal Cancer

Park, In Ja; Kim, Hee Cheol; Yu, Chang Sik; Kim, Jin Cheon

Abstract

PURPOSE: We aimed to verify the pattern of recurrences or metastases of primary colorectal cancer according to regional lymph node metastasis and to use it for follow up.
METHODS
A study was undertaken of 537 stage II and III patients who had undergone a resection of colorectal cancer between July 1989 and December 2002 and who had been identified as having a recurrence during follow up and of 439 stage IV patients who had undergone a resection of the primary tumor during the same period and who could be evaluated for regional lymph node status. Patients were classified into two groups according to regional lymph node status: no lymph node metastasis (214) and lymph node metastasis (762). Univariate and multivariate (Cox's model) analyses of recurrence were employed to identify differences. Statistical significance was assigned to a P value of <0.05.
RESULTS
In the lymph-node-metastasis group, female, poorly differentiated, and infiltrating type cancer were dominant. The patterns of recurrence were hematogenous in 729 cases (74.7%), local recurrence in 101 cases (10.3%), peritoneal seeding in 107 cases (11.0%), and lymph node recurrence in 116 cases (11.9%). Hematogenous metastasis was the most common type of metastasis or recurrence in both groups. Compared with the no-lymph-node-metastasis group, the rates of lymph node recurrence (P<0.01) and local recurrence (P=0.02) were much higher in the were more frequent lymph-node-metastasis group. Local recurrence was frequent in rectal cancer, and the location of the primary tumor greatly influenced on local recurrence. Therefore, lymph node recurrence was strongly influenced by regional lymph node metastasis.
CONCLUSIONS
The pattern of recurrence differed according to the characteristics of the primary tumor. Especially, in the lymph-node-metastasis group, lymph node and local recurrences were more common than they were in the no-lymph-node-metastasis group. Therefore, lymph node metastasis should be considered for follow up.