title: The extramural metastasis might be categorized in lymph node staging for colorectal cancer.
abstract: ABSTRACT:  BACKGROUND: The objective of this study is to assess the clinical significance and prognostic impact of extramural metastasis in colorectal carcinoma and establish an optimal categorization in the staging system. METHODS: To determine the frequency and prognostic significance of extramural metastasis, from 2000 to 2005, a total of 1,215 patients with colorectal cancer who underwent surgical resection were recruited into this study. Individual demographic and clinicopathologic data were collected including tumor stage, nodal stage, tumor histology, degree of tumor differentiation, and presence of lymphovascular invasion. After surgery, all patients received standard treatments and follow-up, which were closed in April 2010. RESULTS: EM was detected in 167 (13.7%) patients and in 230 (1.8%) of the 12,534 nodules retrieved as 'lymph nodes'. The incidence of extramural metastasis was significantly higher in patients with large tumors, deeper invasive depth and more lymph node metastasis (P < 0.001). After curative operation, overall survival was significantly worse for patients with extramural metastasis than those without (P < 0.001). Multivariate analysis identified extramural metastasis as an independent prognostic factor (RR = 2.1, 95%CI:1.5-3.0). By using the Akaike information criterion (AIC), N staging was capable of predicting survival outcome with the highest accuracy when both nodal involvement and extramural metastasis were treated together as N factors(AIC = 1025.3). CONCLUSION: Extramural metastasis might be diagnosed as replaced lymph nodes in the process of classification, thus forming a new categorization.
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P, R, China. zhouzhw@sysucc.org.cn.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Qiu
authors.forename: Gong
authors.initials: G
authors.lastname: Chen
authors.forename: Rajiv P
authors.initials: RP
authors.lastname: Keshari
authors.forename: Hui-Yan
authors.initials: HY
authors.lastname: Luo
authors.forename: Wang
authors.initials: W
authors.lastname: Fang
authors.forename: Miao-Zhen
authors.initials: MZ
authors.lastname: Qiu
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Zhou
authors.forename: Rui-Hua
authors.initials: RH
authors.lastname: Xu