Ann Surg Treat Res.  2018 Oct;95(4):201-212. 10.4174/astr.2018.95.4.201.

Significance of lymph node metastasis in the survival of stage IV colorectal cancer by hematogenous metastasis

• Han EC
• Kwon YH
• Park KJ
• Jeong SY
• Kang SB
• Oh JH
• Heo SC
• for the Seoul Colorectal Group (SECOG)

• KMID: 2421198
• DOI: http://doi.org/10.4174/astr.2018.95.4.201

Abstract

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.

Keyword

Colorectal neoplsms; Neoplasm metastasis; TNM classification

MeSH Terms

Colorectal Neoplasms*
Disease-Free Survival
Humans
Lymph Nodes*
Neoplasm Metastasis*

Figure

• 

  Fig. 1 Number of patients enrolled in each group and exclusion criteria. CRC, colorectal cancer.

• 

  Fig. 2 Kaplan-Meier survival curves of N0M1 and N + M1. (A) Overall survivals (OSs) of N0M1 (5-year OS: 49.7% ± 6.2%, n = 76) and N + M1 (25.1% ± 1.7%, n = 759) (P < 0.001, Log-rank test). (B) OSs of N0M1 (5-year OS: 64.9% ± 7.5%) and N + M1 (45.1% ± 2.8%) with curative resection (P = 0.001) (C) OSs of N0M1 (5-year OS: 20.5% ± 8.5%) and N + M1 (vs. 6.4% ± 1.4%) with palliative resection (P = 0.004) (D) Disease free survivals (DFSs) of N0M1 (5-year DFS: 47.4% ± 7.5%) and N + M1 (23.1 ± 2.3) with curative resection (P = 0.001).

• 

  Fig. 3 Kaplan-Meier survival curves according to N stages. (A) Overall survivals (OSs) of all (n = 835) patients. The 5-year OS's of N0M1, N1M1, N2aM1, and N2bM1 were 49.7% ± 6.2%, 40.7% ± 3.8%, 29.9% ± 3.2%, and 12.8% ± 2.0% each (P = 0.037 for N0M1 vs. N1M1; P = 0.001 for N1M1 vs. N2aM1; P < 0.001 for N2aM1 vs. N2bM1, Log-rank test). (B) OSs of patients with curative resection. The 5-year OS's of N0M1, N1M1, N2aM1 and N2bM1 were 64.9% ± 7.5%, 57.4% ± 4.8%, 55.4% ± 5.1% and 22.7% ± 4.2% each (P = 0.084 for N0M1 vs. N1M1; P = 0.501 for N1M1 vs. N2aM1; P < 0.001 for N2aM1 vs. N2bM1; P = 0.030 for N0M1 vs. N2aM1). (C) OSs of patients with palliative resection. The 5-year OS's of N0M1, N1M1, N2aM1, and N2bM1 were 20.5% ± 8.5%, 9.1% ± 4.3%, 5.6% ± 2.3%, and 5.9% ± 1.9% each (P = 0.152 for N0M1 vs. N1M1; P = 0.014 for N1M1 vs. N2aM1; P = 0.987 for N2aM1 vs. N2bM1). (D) Disease free survivals (DFSs) of patients with curative resection. The 5-year DFS's of N0M1, N1M1, N2aM1, and N2bM1 were 47.4% ± 7.5%, 31.6% ± 4.4%, 26.2% ± 4.3%, and 12.9% ± 3.2% each (P = 0.081 for N0M1 vs. N1M1; P = 0.140 for N1M1 vs. N2aM1; P = 0.026 for N2aM1 vs. N2bM1; P = 0.005 for N0M1 vs. N2aM1).

• 

  Fig. 4 Kaplan-Meier survival curves of patients of N0M1 with curative resection and of stage III. (A) Overall survivals (OSs) of N0M1 (n = 50) with stage IIIA (n = 298), IIIB (n = 2,633), and IIIC (n = 2,521). The 5-year OS's of anyTN0M1, stage IIIa, IIIb, and IIIc were 64.9% ± 7.5%, 87.2% ± 2.2%, 73.2% ± 0.9%, and 47.6% ± 1.1% each (P < 0.001 for anyTN0M1 vs. stage IIIa; P = 0.774 for anyTN0M1 vs. stage IIIb; P = 0.002 for anyTN0M1 vs. stage IIIc, Log-rank test). (B) OSs of N0M1 with stage III according to N stage only. The 5-year OS's of anyTN1M0 (n = 2,932), anyTN2aM0 (n = 1,143), and anyTN2bM0 (n = 1,377) were 74.9% ± 0.9%, 58.3% ± 1.5%, and 38.7% ± 1.4% each (P = 0.587 for anyTN0M1 vs. anyTN1M0; P = 0.063 for anyTN0M1 vs. anyTN2aM0; P < 0.001 for anyTN0M1 vs. anyTN2bM0).

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