Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025
Long-term outcomes and prognostic factor of metachronous para-aortic lymph node metastasis in colorectal cancer.
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Matsuda Takeru, Ito Sono, Kinugasa Yusuke, Ishihara Soichiro, Shiomi Akio, Kanemitsu Yukihide, Kakeji Yoshihiro, Ajioka Yoichi
Аннотация
AIM: Despite the relatively rare incidence of para-aortic lymph node metastasis (PALNM) after surgery for colorectal cancer, it is often fatal, and treatment strategy is still debated. This study aimed to investigate the long-term outcomes of patients with metachronous PALNM and their prognostic factors.
METHOD: Thirty-six institutions belonging to the Japanese Society for Cancer of the Colon and Rectum participated in this retrospective cohort study. A total of 148 patients with metachronous PALNM after resection of primary colorectal cancer between January 2011 and December 2015 were included in the analysis.
RESULTS: Of the 148 patients, 37 received PALNM resection, whereas 111 did not. The primary tumour characteristics were not different between the resection and non-resection groups. The median number of PALNMs was significantly larger and synchronous metastasis other than PALNM was more frequent in the non-resection group than in the resection group (2 vs. 1, P = 0.030; 71.2% vs. 29.7%, P < 0.001). The 5-year overall survival rate in the whole cohort was 30.6%, which was significantly higher in the resection group than in the non-resection group (P < 0.0001). The resection method of PALNM did not affect survival. Undifferentiated tumour, ≥4 PALNMs, synchronous metastasis other than PALNM, and non-resection of PALNM were significant unfavourable prognostic factors in the multivariate Cox regression analysis.
CONCLUSION: PALNM resection appears desirable when it is feasible in patients with metachronous PALNM. However, surgeons should also consider unfavourable prognostic factors including undifferentiated tumour, ≥4 PALNMs and synchronous metastasis other than PALNM.
METHOD: Thirty-six institutions belonging to the Japanese Society for Cancer of the Colon and Rectum participated in this retrospective cohort study. A total of 148 patients with metachronous PALNM after resection of primary colorectal cancer between January 2011 and December 2015 were included in the analysis.
RESULTS: Of the 148 patients, 37 received PALNM resection, whereas 111 did not. The primary tumour characteristics were not different between the resection and non-resection groups. The median number of PALNMs was significantly larger and synchronous metastasis other than PALNM was more frequent in the non-resection group than in the resection group (2 vs. 1, P = 0.030; 71.2% vs. 29.7%, P < 0.001). The 5-year overall survival rate in the whole cohort was 30.6%, which was significantly higher in the resection group than in the non-resection group (P < 0.0001). The resection method of PALNM did not affect survival. Undifferentiated tumour, ≥4 PALNMs, synchronous metastasis other than PALNM, and non-resection of PALNM were significant unfavourable prognostic factors in the multivariate Cox regression analysis.
CONCLUSION: PALNM resection appears desirable when it is feasible in patients with metachronous PALNM. However, surgeons should also consider unfavourable prognostic factors including undifferentiated tumour, ≥4 PALNMs and synchronous metastasis other than PALNM.