Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, P.R. China.
Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, P.R. China;
Anticancer Res. 2023 Sep;43(9):4169-4177. doi: 10.21873/anticanres.16608.
BACKGROUND/AIM: The purpose of this study was to elucidate the status and clinical significance of skip lymph node metastasis (LNM) in colorectal cancer.
This is a retrospective cohort study from a high-volume cancer center in Japan. A total of 1,060 patients with primary stage III colorectal cancer (CRC) underwent radical resection were included in the study and divided into skip LNM (LNM) (skip+) and non-skip LNM (skip-) groups. Propensity score matching was used to balance potential confounding factors. The cancer-specific survival (CSS) and relapse-free survival rate (RFS) between the two groups before and after matching were evaluated.
Before matching, patients in the skip+ group had a greater number of LNM (pN2: 48.3% vs. 31.1%; p<0.001), more pathological stage IIIC (43.2% vs. 17.6%; p<0.001), and a higher rate of recurrence (38.1% vs. 25.8%; p=0.0045). Consequently, the CSS (p=0.034) and RFS (p=0.005) were worse compared to the skip- group. However, after matching, there were no significant differences in prognosis for CSS (p=0.529) and RFS (p=0.515). In multivariate analysis, skip+ was not an independent risk factor for prognosis. However, the skip+ LNM group was more likely to have local lymph node recurrence.
Skip+ LNM was more likely to happen in later stage CRCs, leading to significantly poorer survival outcomes. However, when all background factors were matched, the prognosis of the skip+ group was not worse. Surgeons need to be more alert to the possibility of local recurrence in patients with skip LNM.
背景/目的：本研究旨在阐明结直肠癌跳跃式淋巴结转移（LNM）的现状及其临床意义。
这是一项来自日本一家大容量癌症中心的回顾性队列研究。共有 1060 名接受根治性切除术的原发性 III 期结直肠癌（CRC）患者纳入本研究，并分为跳跃式 LNM（LNM）（跳跃+）和非跳跃式 LNM（跳跃-）组。采用倾向评分匹配来平衡潜在的混杂因素。评估两组匹配前后的癌症特异性生存率（CSS）和无复发生存率（RFS）。
在匹配前，跳跃+组患者的 LNM 数量更多（pN2：48.3%比 31.1%；p<0.001），病理分期更晚（IIIC 期：43.2%比 17.6%；p<0.001），且复发率更高（38.1%比 25.8%；p=0.0045）。因此，与跳跃-组相比，CSS（p=0.034）和 RFS（p=0.005）更差。然而，匹配后，CSS（p=0.529）和 RFS（p=0.515）的预后无显著差异。多变量分析显示，跳跃+不是预后的独立危险因素。然而，跳跃+LNM 组更有可能发生局部淋巴结复发。
跳跃+LNM 更可能发生在晚期 CRC 中，导致生存结果显著恶化。然而，当所有背景因素都匹配时，跳跃+组的预后并不差。外科医生需要更加警惕跳跃式 LNM 患者发生局部复发的可能性。
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