Scatter patterns in lymph node metastases as a novel prognostic indicator in patients with stage III/N2 colorectal cancer

Koike,Takuya; Mukai,Masaya; Hiraiwa,Shinichiro; Kishima,Kyoko; Yokoyama,Daiki; Uda,Shuji; Hasegawa,Sayuri; Tajima,Takayuki; Nomura,Eiji; Sugiyama,Tomoko; Tajiri,Takuma

doi:10.3892/mco.2021.2402

Scatter patterns in lymph node metastases as a novel prognostic indicator in patients with stage III/N2 colorectal cancer

Authors:
- Takuya Koike
- Masaya Mukai
- Shinichiro Hiraiwa
- Kyoko Kishima
- Daiki Yokoyama
- Shuji Uda
- Sayuri Hasegawa
- Takayuki Tajima
- Eiji Nomura
- Tomoko Sugiyama
- Takuma Tajiri
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Affiliations: Department of Surgery, Tokai University Hachioji Hospital, Tokyo 192‑0032, Japan, Department of Pathology, Tokai University Hachioji Hospital, Tokyo 192‑0032, Japan, Department of Surgery, Tokai University Tokyo Hospital, Tokyo 151‑0053, Japan
Published online on: September 21, 2021 https://doi.org/10.3892/mco.2021.2402
Article Number: 239
Copyright: © Koike et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

To classify patients with stage III/N2 colorectal cancer into high‑ and low‑risk groups for recurrence, the present study compared clinicopathological features by immunohistochemical staining. The single‑center analysis included 53/668 patients (7.9%) with stage III/N2 colorectal cancer who underwent radical resection between January 2006 and December 2014. The present study examined cancer cell distribution in metastatic lymph nodes and classified patients into a group with circumferential localization patterns like a cystic mass (CLP) and a group with scatter patterns like fireworks (SPF). Subsequently, 5‑year relapse‑free survival (5Y‑RFS) and 5‑year overall survival (5Y‑OS) rates were compared and the histological type (differentiation degree) of the primary adenocarcinoma was included. The CLP group included 16 patients (30.2%) and the SPF group included 37 patients (69.8%). The 5Y‑RFS rates in these groups were 75.0 vs. 37.8%, respectively (P=0.021), and the 5Y‑OS rates were 81.3 vs. 48.6% (P=0.033). Patient clinicopathological characteristics exhibited no significant differences between groups. The adenocarcinoma was well differentiated in 14 patients (Well; 26.4%) and moderately (Mod; n=37) or poorly (Por; n=2) differentiated in 39 patients (Mod+Por; 73.6%). Patients were further classified into four groups: Well/CLP (n=6), Well/SPF (n=8), Mod+Por/CLP (n=10) and Mod+Por/SPF (n=29). For Well/CLP vs. Well/SPF, the 5Y‑RFS rates were 66.7 vs. 25.0%, respectively (P=0.293), and for Mod+Por/CLP vs. Mod+Por/SPF (80.0 vs. 41.4%; P=0.052), the respective values for 5Y‑OS were 66.7 vs. 50.0% (P=0.552) and 90.0 vs. 48.3% (P=0.059). Based on the aforementioned results, the CLP group was considered a low‑risk group for recurrence with a relatively good prognosis; however, the SPF group was considered a high‑risk group for recurrence with a poor prognosis, suggesting a need for more potent multi‑combination chemotherapy in these patients from the early postoperative period.

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