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. 2016 May 31;7(22):31699-707.
doi: 10.18632/oncotarget.9064.

Limited effect of lymph node status on the metastatic pattern in colorectal cancer

Nikki Knijn  1 , Felice N van Erning  2   3 , Lucy I H Overbeek  4 , Cornelis J A Punt  5 , Valery E P P Lemmens  2   3 , Niek Hugen  6 , Iris D Nagtegaal  1
Affiliations

Limited effect of lymph node status on the metastatic pattern in colorectal cancer

Nikki Knijn et al. Oncotarget. .

Abstract

Regional lymph node metastases in colorectal cancer (CRC) decrease outcome. Whether nodal metastases function as a biomarker, i.e. as a sign of advanced disease, or are in fact involved in the metastatic process is unclear. We evaluated metastatic patterns of CRC according to the lymph node status of the primary tumor.A retrospective review of 1393 patients with metastatic CRC who underwent autopsy in the Netherlands was performed. Metastatic patterns of regional lymph node positive and negative CRC were compared and validated by population-based data from the Eindhoven Cancer Registry (ECR).Patients with regional lymph node positive CRC more often developed peritoneal metastases (28% vs. 21%, p=0.003) and distant lymph node metastases (25% vs. 15%, p <0.001). Incidences of liver and lung metastases were comparable. Data from the ECR confirmed our findings regarding peritoneal (22.4% vs. 17.0%, p=0.003) and distant lymph node metastases (15.8% vs. 9.7%, p <0.001).Regional lymph node positive CRC show a slightly different dissemination pattern, with higher rates of peritoneal and distant lymph nodes metastases. Comparable incidences of liver and lung metastases support the hypothesis that dissemination to distant organs occurs independently of lymphatic spread.

Keywords: Pathology Section; autopsy; blood vessels; colorectal neoplasms; lymph nodes; neoplasm metastasis.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
a Distribution of CRC metastases according to regional lymph node status in the autopsy cohort. Left figure shows the distribution of metastases for regional lymph node negative primary tumors, right figure shows the distribution of metastases for regional lymph node positive primary tumors. * p = 0.003, ** p < 0.001. b. Distribution of CRC metastases according to distant lymph node positivity in the autopsy cohort. Left figure shows the distribution of metastases for primary tumors without distant lymph node metastases, right figure shows the distribution of metastases for primary tumors with distant lymph node metastases. * p < 0.001.
Figure 1
Figure 1
a Distribution of CRC metastases according to regional lymph node status in the autopsy cohort. Left figure shows the distribution of metastases for regional lymph node negative primary tumors, right figure shows the distribution of metastases for regional lymph node positive primary tumors. * p = 0.003, ** p < 0.001. b. Distribution of CRC metastases according to distant lymph node positivity in the autopsy cohort. Left figure shows the distribution of metastases for primary tumors without distant lymph node metastases, right figure shows the distribution of metastases for primary tumors with distant lymph node metastases. * p < 0.001.
Figure 2
Figure 2. Percentage of patients with distant lymph node metastases according to the number of positive lymph nodes in primary tumor
Selection of patients with more than ten lymph nodes examined (N = 1024 pts; autopsy cohort = 258 pts; clinical cohort = 766 pts), p < 0.001.
See this image and copyright information in PMC

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