Apical Node Involvement Does Not Influence Prognosis After Potentially Curative Resection for Stage III Colorectal Cancer

Abstract

Objective:To examine the independent prognostic value of ALN status in patients with stage III CRC.Summary of Background Data:Early CRC staging classified nodal involvement by level of involved nodes in the operative specimen, including both locoregional and apical node status, in contrast to the American Joint Committee on Cancer/tumor nodes metastasis (TNM) system where tumors are classified by the number of nodes involved. Whether ALN status has independent prognostic value remains controversial.Methods:Consecutive patients who underwent curative resection for Stage III CRC from 1995 to 2012 at Concord Hospital, Sydney, Australia were studied. ALN status was classified as: (i) ALN absent, (ii) ALN present but not histologically involved, (iii) ALN present and involved. Outcomes were the competing risks incidence of CRC recurrence and CRC-specific death. Associations between these outcomes and ALN status were compared with TNM N status results.Results:In 706 patients, 69 (9.8%) had an involved ALN, 398 (56.4%) had an uninvolved ALN and 239 (33.9%) had no ALN identified. ALN status was not associated with tumor recurrence [adjusted hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.84–1.26] or CRC-specific death (HR 1.14, CI 0.91–1.43). However, associations persisted between TNM N-status and both recurrence (HR 1.58, CI 1.21–2.06) and CRC-specific death (HR 1.59, CI 1.19–2.12).Conclusions:No further prognostic information was conferred by ALN status in patients with stage III CRC beyond that provided by TNM N status. ALN status is not considered to be a useful additional component in routine TNM staging of CRC.

Construction of a risk prediction model for colorectal cancer prognosis and immunotherapy based on angiogenesis-related gene

“…The aforementioned treatment options, however, do not improve the prognosis for patients with advanced colorectal cancer . The TNM staging approach is now a widely accepted predictor of colorectal cancer prognosis; nonetheless, its low speci city and accuracy severely limit its use (Ng et al, 2020). To provide guidance for the prognosis of colorectal cancer (CRC), more sensitive and speci c markers must be investigated.…”

Comment on “Apical Node Involvement Does Not Influence Prognosis After Potentially Curative Resection for Stage III Colorectal Cancer: A Competing Risks Analysis”

“…We read with great interest and appreciation the excellent article titled “Apical Node Involvement Does Not Influence Prognosis After Potentially Curative Resection for Stage III Colorectal Cancer (CRC): A Competing Risks Analysis” by Kheng-Seong et al 1 …”