Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Int J Clin Oncol. 2022 Mar;27(3):520-527. doi: 10.1007/s10147-021-02095-4. Epub 2021 Nov 27.
Para-aortic lymph node (PALN) metastasis is an ominous manifestation indicating a poor prognosis in colorectal cancer (CRC) patients; however, some treatments prolong survival. In this study, we investigated predictors of prolonged survival in CRC patients after PALN metastasis.
We examined 141 patients with CRC that metastasized to the PALNs from CRC with or without extra-PALN metastasis. Among clinicopathological parameters, factors associated with survival after PALN metastasis were identified by multivariate analyses using Cox's proportional hazard models.
The mean hemoglobin and albumin values at diagnosis were 12.3 g/dL and 3.7 g/dL, respectively. Rectal cancer was predominant (n = 81). Mutated RAS was detected in 43%. One hundred and four patients had differentiated adenocarcinoma. Patients underwent PALN dissection (n = 11), radiotherapy (n = 6), and systemic therapy (n = 120). Biologics were administered to 95 patients. The median survival time was 29.1 months. On multivariate analysis, independent factors associated with reduced survival after PALN metastasis were low albumin (hazard ratio [HR] 2.33 per -1 g/dL), mutated RAS (HR 2.55), other than differentiated adenocarcinoma (HR 2.75), rectal cancer (HR 3.38 against right-sided colon, and 3.48 against left-sided colon), the presence of extra-PALN metastasis (HR 6.56), and no use of biologics (HR 3.04).
This study revealed that hypoalbuminemia as well as RAS mutation, undifferentiated histology, rectal cancer, other site metastasis, and no use of biologics contribute to poor prognosis in CRC patients with PALN metastasis. Nutritional management may be important for improving survival of these patients.
腹主动脉旁淋巴结（PALN）转移是结直肠癌（CRC）患者预后不良的一个危险信号；然而，一些治疗方法可以延长生存时间。在本研究中，我们研究了 CRC 患者 PALN 转移后延长生存的预测因素。
我们检查了 141 例 CRC 患者，这些患者的 CRC 转移到了 PALN 淋巴结，这些患者既有伴有额外 PALN 转移的，也有不伴有额外 PALN 转移的。在临床病理参数中，通过使用 Cox 比例风险模型的多变量分析确定与 PALN 转移后生存相关的因素。
诊断时平均血红蛋白和白蛋白值分别为 12.3 g/dL 和 3.7 g/dL。直肠癌居多（n=81）。检测到突变型 RAS 占 43%。104 例患者为分化型腺癌。11 例患者行 PALN 清扫术，6 例患者行放疗，120 例患者行全身治疗。95 例患者接受了生物制剂治疗。中位生存时间为 29.1 个月。多变量分析显示，PALN 转移后生存时间缩短的独立因素包括低白蛋白（每 -1 g/dL 的风险比 [HR] 2.33）、突变型 RAS（HR 2.55）、非分化型腺癌（HR 2.75）、直肠癌（相对于右半结肠的 HR 为 3.38，相对于左半结肠的 HR 为 3.48）、存在额外 PALN 转移（HR 6.56）和未使用生物制剂（HR 3.04）。
本研究表明，低白蛋白血症以及 RAS 突变、未分化组织学、直肠癌、其他部位转移和未使用生物制剂是导致 CRC 患者 PALN 转移预后不良的因素。营养管理可能对改善这些患者的生存状况很重要。
