Factors influencing lymph node skip metastasis in colorectal cancer: a retrospective study

Bao, Feng; Deng, Zhigang; Wang, Dong; Xianyu, Jianbo; Li, Guoqiang; Xiang, Chunhua; Xiang, Rongchao; Zhi, Xing

doi:10.1111/ans.14268

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…[7][8][9] In relatively rare conditions, lymph node metastasis occurs at nodes far from the primary tumor with pericolic or intermediate nodes sparing, and this has been referred to as lymph node skip metastasis (LNSM) in previous literature. [6][7][8][9][10][11] LNSM has been described in gastric cancer, 12,13 thyroid cancer, 14,15 lung cancer, 16,17 and breast cancer, 18,19 with either a positive or negative impact on survival in line with different tumor types. However, there are few studies that have investigated the prognostic role of LNSM in lymph node-positive colon cancer.…”

Section: Principales Medidas De Resultadomentioning

confidence: 99%

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The Negative Prognostic Impact of Lymph Node Skip Metastasis in Stage III Colon Cancer With pN1 Disease: A Single-Center and Retrospective Cohort Study

Chang

Lin

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:Lymph node skip metastasis is a subgroup of lymph node metastatic patterns with low incidence in node-positive colon cancer. Its clinical significance is still unclear. OBJECTIVE:This study aimed to investigate the prognostic impact of lymph node skip metastasis in stage III colon cancer.DESIGN: This is a retrospective observational analysis. SETTINGS:The study was conducted at the Taipei Veterans General Hospital. PATIENTS:This study included patients with stage III colon cancer who underwent D3 lymphadenectomy between 2006 and 2015. MAIN OUTCOME MEASURES:The patients were divided into a lymph node skip metastasis-positive group and a negative group. Recurrence-free survival and overall survival were compared using Kaplan-Meier curves and log-rank test. Cox regression was applied to identify related risk factors influencing survival.RESULTS: A total of 461 patients were reviewed, and lymph node skip metastasis-positive patients represented 13.2% of our sample. Patients with lymph node skip metastasis tended to present with a higher proportion of right-sided cancer, lower positive lymph nodes, lower lymph node ratio, and higher mean BMI. Liver recurrence was more prevalent in the lymph node skip metastasis group (p = 0.028) than in the negative group. The presence of lymph node skip metastasis was a negative prognostic factor for 5-year recurrence-free survival (51.4% vs 68.7%; p = 0.002) and 5-year overall survival (66.4% vs 80.4%; p = 0.024) in Kaplan-Meier curves and multivariate Cox regression. Subgroup analysis revealed the survival significance of recurrencefree survival (p = 0.001) and overall survival (p = 0.011) in lymph node skip metastasis with pN1 disease. LIMITATIONS:This study was limited by its retrospective design, single-center nature, and sampling error. CONCLUSIONS:Lymph node skip metastasis is an independent negative prognostic factor in stage III colon cancer with pN1 disease. More intensive surveillance may be necessary for patients of this subgroup. See Video Abstract at https://links.lww.com/DCR/C60.

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Section: Principales Medidas De Resultadomentioning

confidence: 99%

“… 23 , 37 Third, the local effect of the primary tumor may block pericolic lymphatic drainage. 11 Fourth, lymph node degeneration in patients who are elderly may facilitate skip metastasis. 38 , 39 Thus, further studies are necessary to clarify the true causes and tumor biology of LNSM.…”

Section: Discussionmentioning

confidence: 99%

The Negative Prognostic Impact of Lymph Node Skip Metastasis in Stage III Colon Cancer With pN1 Disease: A Single-Center and Retrospective Cohort Study

Chang

Lin

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…Patients with LNSM tend to have smaller tumor diameters and shallower tumor invasion than patients in the skipnegative group [12]. Previous studies have found that patients with LNSM have a better prognosis than patients without LNSM after radical D3 lymphadenectomy [11,13]. Because the presence of TDs has a poor prognosis, it seems contradictory that TDs can result in skip metastasis.…”

Section: Discussionmentioning

confidence: 99%

A Case of Colon Cancer with Extramural Tumor Deposits in the Main Lymph Node Area: A Case Report

Ono,

Ida,

Ogimi

et al. 2023

J Anus Rectum Colon

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A 72-year-old man with type 2 sub-circumferential tumors in the descending colon and two nodules around the pedicle of the inferior mesenteric artery (main lymph node area) underwent laparoscopic left hemicolectomy with D3 lymphadenectomy. Two lymph nodes around the inferior mesenteric artery pedicle were completely excised. Pathological examination revealed a moderately differentiated tubular adenocarcinoma. Nodules were only found in the main lymph node area, and no lymph node structures were observed in these nodules. These tumor deposits (TDs) may be extramural TDs without lymph node structure or lymph node skip metastasis. The presence of TDs in colorectal cancer is associated with an adverse prognosis, and the requirement of chemotherapy in such cases should be examined. Therefore, it is important to correctly recognize TDs and categorize the disease into a high- or low-risk group within stage III. We report this case because it is necessary to review the definition of TDs, and the assessment of extramural TDs remains controversial.

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“…In the TNM stage of colon cancer after surgery, pT1-2 and pN1 are independent risk factors for skipping metastasis in colon cancer. [10] 2.4 Tumor staging TNM staging, proposed by Pierre Denoix, is a commonly used clinical staging method for epithelial malignancies. Clinically, T, N and M indicate primary tumor lesion, lymph node involvement and distant circulatory metastasis respectively.…”

Section: Mode Of Lymph Node Metastasismentioning

confidence: 99%

“…According to the 2019 Guidelines for the Treatment of Colorectal Cancer compiled by the Japanese Colon and Rectal Cancer Association (JSCCR), [10] it is emphasized that lymph nodes should be thoroughly dissected at the peribowel, mesentery, and mesenteric artery roots at the same time as colon cancer lesions are resected. In surgery, the degree of lymph node dissection is determined based on the clinical diagnosis and the likelihood of lymph node metastasis observed during surgery.…”

Section: D3 Colon Cancer Radical Surgerymentioning

confidence: 99%

Research progress in colon cancer surgery

Sileng,

2023

DCC

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Colon cancer is one of the top three malignant tumors in the world, in recent years, the incidence and mortality of this disease are increasing, which seriously threatens human life and health. At present, surgery is still the main treatment for colon cancer, combined with chemotherapy and other measures can effectively improve the survival of patients. Different surgical methods have different prognostic effects on patients. In terms of intraoperative lymph node dissection for colon cancer, lymph node dissection during total mesocolic resection and D3 radical resection has significantly improved prognosis for colon cancer. Lymph node metastasis of colon cancer is common, with the presence of skip metastasis, lymph node dissection is important for the prognosis of patients, tumor recurrence and tumor metastasis. Therefore, it is necessary to make clear the diagnosis and lymph node metastasis before surgery, determine the surgical procedure and the scope of lymph node dissection, so as to avoid postoperative complications caused by inadequate tumor recurrence or excessive clearance.

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Factors influencing lymph node skip metastasis in colorectal cancer: a retrospective study

Abstract: pT1-2 stage and pN1 stage are significantly associated with LNSM. Radical D3 lymphadenectomy should remain standard practice for CRC.

Cited by 7 publications

References 39 publications

The Negative Prognostic Impact of Lymph Node Skip Metastasis in Stage III Colon Cancer With pN1 Disease: A Single-Center and Retrospective Cohort Study

The Negative Prognostic Impact of Lymph Node Skip Metastasis in Stage III Colon Cancer With pN1 Disease: A Single-Center and Retrospective Cohort Study

A Case of Colon Cancer with Extramural Tumor Deposits in the Main Lymph Node Area: A Case Report

Research progress in colon cancer surgery

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