Department of Surgery, Helios University Hospital Wuppertal, Witten-Herdecke University, Heusnerstr, 40 42283, Wuppertal, Germany.
Department of Visceral, Minimally Invasive and Oncologic Surgery, Marien Hospital Düsseldorf, Rocchusstr. 2, 40479, Düsseldorf, Germany.
Int J Colorectal Dis. 2018 Apr;33(4):403-409. doi: 10.1007/s00384-018-2991-0. Epub 2018 Mar 8.
Colorectal cancer (CRC) is the second leading cause for cancer-related death in industrialized nations. Nodal involvement has been identified as a relevant prognostic feature in CRC. Extra nodal metastasis (ENM) describes the spread of malignant cells beyond the nodal capsule. ENM is thought to be an independent risk factor for poor survival. This study examined ENM as an independent risk factor for poor overall survival in patients with node-positive CRC.
Data from a prospectively maintained CRC database was retrospectively analyzed. Blinded slides of patients with stage III and IV CRC following radical surgical resection were re-examined for the presence of ENM. The effect of ENM on overall survival was examined using Kaplan-Meier curves.
One hundred forty-seven cases with node-positive CRC (UICC stages III and IV) including 78 cases with ENM were included for analysis. ENM was seen in 60 patients with colon cancer (58.8%) and in 18 patients with rectal cancer (40%), p = 0.033. ENM-positive patients had a significantly higher odd for cancer-related death compared to ENM-negative patients ratio of [OR 0.44: 0.22-0.88, CI 95%, p = 0.021], p = 0.02. The median overall survival was significantly longer in patients without ENM, 51.0 ± 33 vs. 30.5 ± 42 months, p = 0.02.
Extra nodal metastasis is an independent prognostic factor in patients with node-positive colorectal cancer. Extra nodal metastasis is associated with high odds of tumor-related mortality and poor overall survival.
结直肠癌（CRC）是工业化国家癌症相关死亡的第二大原因。淋巴结受累已被确定为 CRC 的相关预后特征。额外的淋巴结转移（ENM）描述了恶性细胞超出淋巴结包膜的扩散。ENM 被认为是生存不良的独立危险因素。本研究检查了 ENM 是否是淋巴结阳性 CRC 患者总体生存不良的独立危险因素。
回顾性分析了来自前瞻性维护的 CRC 数据库的数据。对接受根治性手术切除的 III 期和 IV 期 CRC 患者的盲法切片进行重新检查，以确定是否存在 ENM。使用 Kaplan-Meier 曲线检查 ENM 对总生存的影响。
包括 78 例 ENM 患者在内的 147 例淋巴结阳性 CRC（UICC 分期 III 和 IV）病例被纳入分析。ENM 见于 60 例结肠癌患者（58.8%）和 18 例直肠癌患者（40%），p=0.033。ENM 阳性患者的癌症相关死亡风险明显高于 ENM 阴性患者[比值比（OR）0.44：0.22-0.88，95%置信区间（CI），p=0.021]，p=0.02。无 ENM 患者的总生存中位数明显更长，为 51.0±33 个月 vs. 30.5±42 个月，p=0.02。
ENM 是淋巴结阳性结直肠癌患者的独立预后因素。ENM 与肿瘤相关死亡率高和总体生存不良相关。
