Cribriform lymph node pattern is an independent risk factor for metachronous or synchronous distant metastasis in patients with stage III and IV node-positive colorectal cancer. Multivariable analysis in patients with stage III disease indicated that the cribriform pattern of carcinoma in the lymph nodes was an independent risk factor for recurrence and survival. Kaplan–Meier analysis demonstrated that the group with stage III cribriform-type lymph node carcinoma had shorter recurrence-free and overall survival times than the stage III group with the tubular type (P < 0.001).
Background
A primary colorectal cancer (CRC) tumor can contain heterogeneous cancer cells. As clones of cells with different properties metastasize to lymph nodes (LNs), they could show different morphologies. Cancer histologies in LNs of CRC remains to be described.
Methods
Our study enrolled 318 consecutive patients with CRC who underwent primary tumor resection with lymph node dissection between January 2011 and June 2016. 119 (37.4%) patients who had metastatic LNs (mLNs) were finally included in this study. Cancer histologies in LNs were classified and compared with pathologically diagnosed differentiation in the primary lesion. The association between histologies in lymph node metastasis (LNM) and prognosis in patients with CRC was investigated.
Results
The histologies of the cancer cells in the mLNs were classified into four types: tubular, cribriform, poorly differentiated, and mucinous. Same degree of pathologically diagnosed differentiation in the primary tumor produced various histological types in LNM. In Kaplan–Meier analysis, prognosis was worse in CRC patients with moderately differentiated adenocarcinoma who had at least some mLN also showing cribriform carcinoma than for those whose mLNs all showed tubular carcinoma.
Conclusions
Histology in LNM from CRC might indicate the heterogeneity and malignant phenotype of the disease.
Cribriform carcinoma in lymph nodes (LNs) is associated with distant metastasis, recurrence, and survival in node-positive colorectal cancer (CRC) patients. However, the clinical significance of lymph node metastasis histology remains to investigate. A total of 318 consecutive CRC patients who underwent a colectomy or anterior resection between January 2011 and June 2016 were enrolled, of whom 119 (37.4 %) had LN metastasis (LNM). Based on the LNM histology, patients with LNM were categorized into four groups: the group with tubular-type in all LNs (tub), with cribriform in at least one LN (cri), with mucinous-type in all LNs (muc), and with poorly differentiated-type carcinoma in at least one LN (por). We investigated the association among these histological types with the survival of these patients. The prognosis was good in order of muc, tub, cri, and por in node-positive CRC patients. Stage II and stage III tub groups did not have significantly different over-all survival times, but not recurrence-free survival times. Multivariate analyses revealed that all tubular-type carcinoma in LNs was independent predictive factor for longer survival times, clinical complete response and possible metastasectomy Diagnosis of lymph node metastatic histology is an important factor for patient stratification in node-positive CRC.
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