title: The prognostic significance of extracapsular lymph node involvement in node positive patients with colonic cancer.
abstract: OBJECTIVE
  In colonic cancer the prognostic significance of extracapsular lymph node involvement (LNI) is not established and is therefore the objective of this study.
  
  
  METHODS
  Between January 1994 and May 2005, all patients who underwent resection for primary colonic cancer with lymph node metastasis were reviewed. All resected lymph nodes were re-examined to assess extracapsular LNI. In uni- and multivariate analysis disease-free survival (DFS) was correlated with various clinicopathologic factors.
  
  
  RESULTS
  One hundred and eleven patients were included. In 58 patients extracapsular LNI was identified. Univariate analysis revealed that pN-stage (5-year DFS pN1 vs. pN2: 65% vs. 14%, p<0.001), extracapsular LNI (5-year DFS intracapsular LNI vs. extracapsular LNI: 69% vs. 41%, p=0.003), and lymph node ratio (5-year DFS <0.176 vs. > or =0.176: 67% vs. 42%, p=0.023) were significant prognostic indicators. Among these variables pN-stage (hazard ratio 3.5, 95% confidence interval [CI]: 1.72-7.42) and extracapsular LNI (hazard ratio 1.98, 95% CI: 1.00-3.91) were independent prognostic factors. Among patients without extracapsular LNI, those receiving adjuvant chemotherapy had a significantly better survival (p=0.010). In contrast, chemotherapy did not improve DFS in patients with extracapsular LNI.
  
  
  CONCLUSIONS
  Together with pN2 stage, extracapsular LNI reflects a particularly aggressive behaviour and has significant prognostic potential.
authors.affiliation: Department of Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wind
authors.forename: F J W
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: J J S
authors.initials: JJ
authors.lastname: Kiewiet
authors.forename: S M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: J F M
authors.initials: JF
authors.lastname: Slors
authors.forename: J J B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents