The extramural metastasis might be categorized in lymph node staging for colorectal cancer

BMC Cancer

Rui-Hua Xu⁴  Zhi-Wei Zhou¹  Miao-Zhen Qiu⁴  Wang Fang³  Rajiv P Keshari¹  Gong Chen²  Hai-Bo Qiu¹ 

[1]Department of Gastric & Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China

[2]Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China

[3]Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China

[4]Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China

关键词: colorectal cancer;    staging;    extramural metastasis;   

Others  :  1080721
DOI  :  10.1186/1471-2407-11-414

 received in 2010-12-11, accepted in 2011-09-26,  发布年份 2011

【 摘 要 】

Background

The objective of this study is to assess the clinical significance and prognostic impact of extramural metastasis in colorectal carcinoma and establish an optimal categorization in the staging system.

Methods

To determine the frequency and prognostic significance of extramural metastasis, from 2000 to 2005, a total of 1,215 patients with colorectal cancer who underwent surgical resection were recruited into this study. Individual demographic and clinicopathologic data were collected including tumor stage, nodal stage, tumor histology, degree of tumor differentiation, and presence of lymphovascular invasion. After surgery, all patients received standard treatments and follow-up, which were closed in April 2010.

Results

EM was detected in 167 (13.7%) patients and in 230 (1.8%) of the 12,534 nodules retrieved as 'lymph nodes'. The incidence of extramural metastasis was significantly higher in patients with large tumors, deeper invasive depth and more lymph node metastasis (P < 0.001). After curative operation, overall survival was significantly worse for patients with extramural metastasis than those without (P < 0.001). Multivariate analysis identified extramural metastasis as an independent prognostic factor (RR = 2.1, 95%CI:1.5-3.0). By using the Akaike information criterion (AIC), N staging was capable of predicting survival outcome with the highest accuracy when both nodal involvement and extramural metastasis were treated together as N factors(AIC = 1025.3).

Conclusion

Extramural metastasis might be diagnosed as replaced lymph nodes in the process of classification, thus forming a new categorization.

【 授权许可】

   
2011 Qiu et al; licensee BioMed Central Ltd.

【 图 表 】

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