Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives

Abstract

Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.

Distant Metastasis in Colorectal Cancer Patients—Do We Have New Predicting Clinicopathological and Molecular Biomarkers? A Comprehensive Review

“…In any case, the tumor-node-metastasis (TNM) staging system has been accepted in everyday practice due to its prognostic capability and simplicity of N staging. The status of the lymph nodes is also an important factor in determining the application of adjuvant chemotherapy after surgical resection [ 4 ].…”

Small Molecules for Multi-Wavelength Near-Infrared Fluorescent Mapping of Regional and Sentinel Lymph Nodes in Colorectal Cancer Staging

“…After intravenous injection, PanLN-Forte exhibited reduced background signal in key organs such as the liver, unlike the previously described Cy5.5 polymers and ZW800-3A, while maintaining PanLN homing ability ( 17 , 18 ). Despite finding uptake of PanLN-Forte in the liver and, to a lesser extent, in cartilage, these structures can be shielded during a surgical procedure, and are generally far away from the mesenteric LNs that play a relevant role in CRC LN metastasis ( 30 ). The optimal dose of 5 nmol translates to a human equivalent dose of 0.015 mg/kg, which is a low dose and similar to that of other recently clinically tested fluorophores for anatomic enhancement ( 31 , 32 ).…”

Increased Expression of VANGL1 is Predictive of Lymph Node Metastasis in Colorectal Cancer: Results from a 20-Gene Expression Signature

“…However, it is known that 5-year overall survival (OS) highly varies according to important prognostic factors, such the pTs stage (stages II and III) and the involvement of lymph nodes (pN1 and pN2 stage III) [ 1 , 2 , 3 ]. Overall, lymph node metastasis (LNM) is a key prognostic factor for the determination of CRC outcomes and significantly relates to poorer prognosis, disease-free survival (DFS), and OS [ 4 , 5 ].…”