Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan.
PeerJ. 2024 Jul 9;12:e17702. doi: 10.7717/peerj.17702. eCollection 2024.
Appropriate prognostic indicators are required for patients with stage IV colorectal cancer (CRC). Lymph node metastasis mainly involves four histological types of CRC. Some metastatic lymph nodes (mLNs) showing cribriform carcinoma are associated with distant metastasis in patients with node-positive CRC and are correlated with recurrence and survival in stage III disease. However, the significance of mLN histology in the prognosis of patients with node-positive stage IV disease remains unclear.
We enrolled 449 consecutive patients with CRC who underwent primary tumor resection with lymph node dissection between January 2011 and November 2018. This study included 88 patients with node-positive stage IV CRC and synchronous or metachronous distant metastases. We retrospectively investigated the association between cancer histology in the mLNs based on our classification and cancer-specific survival (CSS) in patients with node-positive stage IV CRC.
Kaplan-Meier analysis showed that CSS was better in patients with CRC and all the mLNs showing tubular-type carcinoma. In contrast, patients with at least some mLNs showing poorly differentiated-type carcinoma had poor prognosis. Multivariate analysis showed that "all mLNs showing tubular-type carcinoma" was an independent good prognostic factor for CSS in patients with node-positive stage IV CRC. In addition, "at least some mLNs showing poorly differentiated-type carcinoma" was an independent poor prognostic factor for CSS in patients with node-positive stage IV disease.
The histological type of the mLN may indicate a better or poor prognosis for patients with stage IV CRC.
对于 IV 期结直肠癌（CRC）患者，需要适当的预后指标。淋巴结转移主要涉及 CRC 的四种组织学类型。一些表现为筛状癌的转移性淋巴结（mLN）与阳性淋巴结 CRC 患者的远处转移有关，与 III 期疾病的复发和生存相关。然而，mLN 组织学在阳性淋巴结 IV 期疾病患者预后中的意义仍不清楚。
我们纳入了 2011 年 1 月至 2018 年 11 月期间接受原发肿瘤切除术和淋巴结清扫术的 449 例连续 CRC 患者。本研究包括 88 例阳性淋巴结 IV 期 CRC 伴同步或异时性远处转移的患者。我们回顾性地研究了基于我们分类的 mLN 中的癌症组织学与阳性淋巴结 IV 期 CRC 患者的癌症特异性生存（CSS）之间的关联。
Kaplan-Meier 分析显示，CRC 患者和所有 mLN 均显示管状型癌的 CSS 更好。相比之下，至少有一些 mLN 显示低分化型癌的患者预后较差。多变量分析显示，“所有 mLN 均显示管状型癌”是阳性淋巴结 IV 期 CRC 患者 CSS 的独立良好预后因素。此外，“至少有一些 mLN 显示低分化型癌”是阳性淋巴结 IV 期疾病患者 CSS 的独立不良预后因素。
mLN 的组织学类型可能提示 IV 期 CRC 患者的预后较好或较差。
