• Annals of surgery · Jul 2022

    Apical Node Involvement Does Not Influence Prognosis After Potentially Curative Resection for Stage III Colorectal Cancer: A Competing Risks Analysis.

    • Kheng-Seong Ng, Owen F Dent, Charles Chan, Ronald C Newland, Anil Keshava, Peter Stewart, RickardMatthew J F XMJFXColorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.Discipline of Surgery, Sydney Medical School, The University of Sydney, New South Wales, Australia., and Pierre H Chapuis.
    • Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
    • Ann. Surg. 2022 Jul 1; 276 (1): e24-e31.

    ObjectiveTo examine the independent prognostic value of ALN status in patients with stage III CRC.Summary Of Background DataEarly CRC staging classified nodal involvement by level of involved nodes in the operative specimen, including both locoregional and apical node status, in contrast to the American Joint Committee on Cancer/tumor nodes metastasis (TNM) system where tumors are classified by the number of nodes involved. Whether ALN status has independent prognostic value remains controversial.MethodsConsecutive patients who underwent curative resection for Stage III CRC from 1995 to 2012 at Concord Hospital, Sydney, Australia were studied. ALN status was classified as: (i) ALN absent, (ii) ALN present but not histologically involved, (iii) ALN present and involved. Outcomes were the competing risks incidence of CRC recurrence and CRC-specific death. Associations between these outcomes and ALN status were compared with TNM N status results.ResultsIn 706 patients, 69 (9.8%) had an involved ALN, 398 (56.4%) had an uninvolved ALN and 239 (33.9%) had no ALN identified. ALN status was not associated with tumor recurrence [adjusted hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.84-1.26] or CRC-specific death (HR 1.14, CI 0.91-1.43). However, associations persisted between TNM N-status and both recurrence (HR 1.58, CI 1.21-2.06) and CRC-specific death (HR 1.59, CI 1.19-2.12).ConclusionsNo further prognostic information was conferred by ALN status in patients with stage III CRC beyond that provided by TNM N status. ALN status is not considered to be a useful additional component in routine TNM staging of CRC.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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