Metachronous metastasis confined to isolated lymph node after curative treatment of colorectal cancer
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ORIGINAL ARTICLE
Metachronous metastasis confined to isolated lymph node after curative treatment of colorectal cancer Jeonghee Han 1 & Kang Young Lee 2 & Nam Kyu Kim 2 & Byung Soh Min 2 Accepted: 6 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The incidence of lymph node metastasis (LNM) in colorectal cancer is known to be 2–6%, but little data are available regarding metachronous metastasis confined to isolated LN. The aim of this study is to determine the distribution of isolated LNM and the risk factors for survival of isolated LNM in colorectal cancer. Methods We retrospectively reviewed consecutive patients with colorectal adenocarcinoma between January 2008 and December 2015 at a tertiary referral center. A total of 5902 patients with biopsy-proven colorectal adenocarcinoma treated via surgery were included. Multivariate Cox proportional hazards analysis was used to identify prognostic factors for overall survival. Results Of the 5902 patients, recurrent cases were 1326. Among the relapsed patients, 301 patients had isolated LNM (22.69%). Para-aortic (48.8%), pelvic (29.9%), and Lung hilum (10.0%) were the most common sites of isolated LNM; there were statistically significant differences in the distribution of isolated LNM between the colon and rectal cancer (p = 0.02). Approximately 80% of isolated LNM were diagnosed within 3 years. Multidisciplinary therapy for LNM, diagnosis time to LNM, the T-stage, and histological type of primary cancer were identified as independent prognostic factors for overall survival. Conclusion This study suggests that multidisciplinary management is a potentially effective treatment strategy for isolated LNM. Since time to LNM, the T-stage, and histological type are prognostic factors, an active follow-up program for colorectal cancer is required. Keywords Lymph node . Metastasis . Colorectal cancer
Introduction Most cancer patients die from aggravation of local or distant metastasis. The same is true for colorectal cancer and metastasis of primary cancers can occur in various parts of the body. The progression of cancer metastases is known to occur due to various interactions between cancer cells and the environment of surrounding organs. Although many studies have been conducted on the incidence of cancer metastasis, the exact mechanisms have not been fully understood.
* Byung Soh Min [email protected] 1
Division of colorectal surgery, Department of Surgery, Hallym University College of Medicine, Chuncheon, South Korea
2
Division of colorectal surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Ku, Seoul 03722, South Korea
Patients without metastases at the first diagnosis of colorectal cancer eventually develop metachronous metastases in 14–34% of patients [1–4]. Metachronous metastases of colorectal cancer have been reported differently depending on primary cancer. In the case of colon cancer, metastases appear in the order of liver, lung, peritoneum, lymph node, and in the case of
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