The Clinical Impact of Apical Lymph Node Metastasis of Colorectal Cancer After Curative Resection

Poor prognosis in stage III colorectal cancer with apical lymph node metastasis: a single-center retrospective study

The impact of apical lymph node (ALN) status on the prognosis of colorectal cancer (CRC) remains controversial, and ALN status is not included in the current Tumor Node Metastasis (TNM) staging system. This study aimed to evaluate the effect of ALN status on recurrence and survival rates. In this retrospective study, 117 stage 3 CRC patients aged over 18 who underwent surgery between 2015 and 2024 and had their ALN status determined were evaluated. Patients with metastatic disease at diagnosis, those with undetermined ALN status, and those with concurrent malignancies were excluded. Patients were analyzed based on demographic, clinical, pathological, and survival data. The median age was 61 years (range: 33–83), and 60.7% of the patients were male. The pN stage was significantly more advanced (p < 0.001) and the number of metastatic lymph nodes was significantly higher (p = 0.003) in the ALN ( +) group. During a median follow-up of 46 months, 14 local recurrences, 31 systemic recurrences, and 27 cancer-related deaths were observed. Local recurrence, systemic recurrence, and cancer-related deaths were significantly more frequent in the ALN ( +) group (p = 0.027, p < 0.001, and p < 0.001, respectively). Locoregional disease-free survival, systemic disease-free survival and overall survival were significantly shorter in the ALN ( +) group (p = 0.011, p < 0.001, and p < 0.001, respectively). In multivariate analysis, SDFS and OS were found to be significantly shorter in the ALN ( +) and pN2 groups. ALN metastasis can be considered as an additional adverse prognostic factor in CRC beyond the pN stage.

Are Metastatic Central Lymph Nodes (D3 volume) in right-sided Colon Cancer a Sign of Systemic Disease? A sub-group Analysis of an Ongoing Multicenter Trial

OBJECTIVE

Assess outcomes of patients with right-sided colon cancer with metastases in the D3 volume after personalized surgery.

BACKGROUND

Patients with central lymph node metastasis (D3-PNG) are considered to have a systemic disease with a poor prognosis. A 3-dimensional definition of the dissection volume allows the removal of all central nodes.

MATERIALS AND METHODS

D3-PNG includes consecutive patients from an ongoing clinical trial. Patients were stratified into residual disease negative (D3-RDN) and residual disease positive (D3-RDP) groups. D3-RDN was further stratified into 4 periods to identify a learning curve. A personalized D3 volume (defined through arterial origins and venous confluences) was removed " en bloc" through medial-to-lateral dissection, and the D3 volume of the specimen was analyzed separately.

RESULTS

D3-PNG contained 42 (26 females, 63.1 SD 9.9 y) patients, D3-RDN:29 (17 females, 63.4 SD 10.1 y), and D3-RDP:13 (9 females, 62.2 SD 9.7 y). The mean overall survival (OS) days were D3-PNG:1230, D3-RDN:1610, and D3-RDP:460. The mean disease-free survival (DFS) was D3-PNG:1023, D3-RDN:1461, and D3-RDP:74 days. The probability of OS/DFS were D3-PNG:52.1%/50.2%, D3-RDN:72.9%/73.1%, D3-RDP: 7.7%/0%. There is a significant change in OS/DFS in the D3-RDN from 2011-2013 to 2020-2022 (both P =0.046) and from 2014-2016 to 2020-2022 ( P =0.028 and P =0.005, respectively).

CONCLUSION

Our results indicate that surgery can achieve survival in most patients with central lymph node metastases by removing a personalized and anatomically defined D3 volume. The extent of mesenterectomy and the quality of surgery are paramount since a learning curve has demonstrated significantly improved survival over time despite the low number of patients. These results imply a place for the centralization of this patient group where feasible.

The invasive margin of early-stage human colon tumors is infiltrated with neutrophils of an antitumoral phenotype

Neutrophils infiltrate several types of cancer; however, whether their presence is associated with disease progression remains controversial. Here, we show that colon tumors overexpress neutrophil chemoattractants compared to healthy tissues, leading to their recruitment to the invasive margin and the central part of colon tumors. Of note, tumor-associated neutrophils expressing tumor necrosis factor α, which usually represents an antitumoral phenotype, were predominantly located in the invasive margin. Tumor-associated neutrophils from the invasive margin displayed an antitumoral phenotype with higher ICAM-1 and CD95 expression than neutrophils from healthy adjacent tissues. A higher neutrophil/lymphocyte ratio was found at later stages compared to the early phases of colon cancer. A neutrophil/lymphocyte ratio ≤3.5 predicted tumor samples had significantly more neutrophils at the invasive margin and the central part. Moreover, tumor-associated neutrophils at the invasive margin of early-stage tumors showed higher ICAM-1 and CD95 expression. Coculture of colon cancer cell lines with primary neutrophils induced ICAM-1 and CD95 expression, confirming our in situ findings. Thus, our data demonstrate that tumor-associated neutrophils with an antitumoral phenotype characterized by high ICAM-1 and CD95 expression infiltrate the invasive margin of early-stage colon tumors, suggesting that these cells can combat the disease at its early courses. The presence of tumor-associated neutrophils with antitumoral phenotype could help predict outcomes of patients with colon cancer.