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Apical node metastasis independently predicts poor survival in Dukes C colorectal cancer
Author(s) -
Ang C. W.,
Tweedle E. M.,
Campbell F.,
Rooney P. S.
Publication year - 2011
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2010.02188.x
Subject(s) - medicine , colorectal cancer , oncology , metastasis , distant metastasis , cancer
Aim The prognostic significance of apical node metastasis in node‐positive colorectal cancer (CRC) is disregarded by the Fourth American Joint Committee on Cancer and the International Union Against Cancer (AJCC/UICC) TNM classification system. The influence of apical node metastases on overall 5‐year survival among patients with Dukes stage C CRC was examined. Method Patients who underwent operative resection for CRC between 1999 and 2003 were reviewed. Results Two‐hundred and ninety patients were included in the study, including 203 with Dukes C apical node‐negative cancers, 39 with Dukes C apical node‐positive cancers and 48 with Dukes D cancers. The respective prevalence of extramural vascular invasion was 35% vs 64% vs 56% ( P = 0.0005), T4‐stage 24% vs 38% vs 48% ( P = 0.013), positive resection margin 16% vs 41% vs 23% ( P = 0.001), more than three positive nodes harvested 28% vs 85% vs 52% ( P < 0.0001) and poorer tumour differentiation grade 9% vs 21% vs 23% ( P = 0.009). Multivariate analyses of all Dukes C cancer patients ( n = 242) showed a positive apical node to be a highly significant independent predictor of mortality (hazard ratio 2.281, 95% confidence interval 1.421–3.662, P = 0.0006). Extramural vascular invasion and a positive resection margin were also independent predictors of poor survival. Patients with Dukes C apical node‐positive cancers had a significantly poorer overall 5‐year survival compared to patients with Dukes C apical node‐negative cancers ( P < 0.0001) but survival was not significantly different compared to patients with distant metastases at initial presentation ( P = 0.504). Conclusion Apical node metastasis appears to be a strong independent, negative prognostic factor of poor survival in Dukes C CRC.