Patients with extensive regional lymph node involvement (pN2) following potentially curative surgery for colorectal cancer are at increased risk for developing peritoneal metastases: a retrospective single‐institution study

Abstract

Aim Our goal was to determine the incidence and clinical behaviour of peritoneal metastases (PM) in patients with colorectal cancer undergoing potentially curative surgery, comparing patients with extensive locoregional lymph node involvement (pN2) with those who have serosal involvement (pT4), a known risk factor for developing PM. Method A retrospective analysis of a prospectively maintained database was performed. All patients with pT4 and pN2 were included in the analysis. The diagnostic criteria were the finding of PM during surgery with biopsy confirmation as well as imaging features suggestive of PM, including ovarian metastases and omental deposits. Results Two hundred and fourteen patients treated between May 2010 and October 2015 were included. Of these, 110 (51.4%) had pT4 and 131 (61.2%) pN2 tumours: 17.2% of patients with pT4 tumours and 20.2% of patients with pN2 tumours developed PM (P = 0.53). The median time to detection of PM was 16.6 months and 11.8 months for pT4 and pN2 tumours, respectively. PM were isolated in 51.8% of patients with pN2 tumours. Nonperitoneal metastases developed in 37.5% of patients with pN2 tumours. In pN2 tumours, the incidence of PM was higher in signet ring cell and mucinous tumours (P < 0.01), positive surgical margins (P = 0.02), colonic versus rectal tumours (P = < 0.01) and right colon primary tumours (P = 0.01). Conclusion Patients with pN2 tumours are at an increased risk of developing PM, which is similar to the risk in pT4 tumours. pN2 tumours should be included in clinical trials evaluating preventive/proactive strategies. There is a need to identify predictive biomarkers for the development of PM versus other sites of metastasis.

Development of a Nomogram to Predict Postoperative Peritoneal Metastasis of Colon Cancer

“…13 Patients with N2 tumors are at increased risk of developing peritoneal metastases, similar to T4 tumors. 20 However, the mechanisms underlying lymph node metastasis and peritoneal carcinomatosis remain unclear.…”

“…The median peritoneal metastasis-free survival time of the nonadenocarcinoma group was 62 months, which was significantly shorter than that of the adenocarcinoma group. The association of peritoneal metastasis with advanced N stage indicates that tumors with general high malignancy characteristics may also be capable of peritoneal dissemination and that cancer cells invade both “transmesothelially” and “translymphatically.” 13 Patients with N2 tumors are at increased risk of developing peritoneal metastases, similar to T4 tumors 20 . However, the mechanisms underlying lymph node metastasis and peritoneal carcinomatosis remain unclear.…”

The molecular biology of peritoneal metastatic disease

“…Tumor cells already present within the peritoneal cavity redistribute via these routes as well. Extensive regional lymph node involvement is considered a risk factor for the development of PM in nonserosa invasive GC (Huang et al , 2013) and CRC (Bhatt et al , 2019). As for the hematogenous route, a parabiosis mouse model of ovarian cancer, where mice share the same circulation, demonstrated the formation of omental metastases via the bloodstream (Pradeep et al , 2014).…”

A nomogram for preoperative differentiation of tumor deposits from lymph node metastasis in rectal cancer: A retrospective study

“…[1] Tumor deposits (TDs) and lymph nodes metastases (LNM) both were important prognostic indicators for the overall survival of RC patients. [2][3][4][5] Both of them were peritumoral nodules, but they had different mechanisms of occurrence, and corresponding to different tumor stages, treatment strategies and survival outcomes. [6][7][8][9] In clinical practice, it was difficult to distinguish TDs from LNM by morphology and signal character of nodules.…”