Hepatic lymph node metastases in patients with colorectal liver metastases undergoing hepatic artery infusion pump placement.

BACKGROUNDS/AIMS: The status of portal lymph nodes is a critical factor in determining eligibility for hepatic artery infusion pump (HAIP) therapy. However, methods for detecting occult positive nodes and understanding their clinical implications remain inadequately defined.

METHODS

We conducted a retrospective evaluation of a cohort of patients with metastatic colorectal cancer who underwent HAIP. An independent, blinded radiologist reviewed pre-operative imaging to identify predictors for nodal positivity. We performed Kaplan-Meier survival analyses to explore the relationship between hepatic nodal staging and patient survival.

RESULTS

The study comprised 33 patients, with a median follow-up of 23.5 months (range 2-56 months). The imaging review did not accurately identify patients with hepatic nodal disease. Patients without hepatic nodal metastases (n = 23) had a significantly longer median overall survival (OS) of 27 months compared to those with hepatic nodal metastases, who had a median OS of 11 months (hazard ratio = 4.8, p ≤ 0.01). Hepatic nodal positivity (hLN+) was associated with primary nodal positivity (pLN+, p = 0.036), and all patients with hLN+ were also pLN+.

CONCLUSIONS

Hepatic nodal metastases are a predictor of survival in patients receiving HAIP therapy for colorectal liver metastases. Primary nodal positivity may aid in the selection of HAIP candidates by increasing the suspicion of hepatic nodal positivity.