title: Extranodal metastasis predicts poor survival in advanced colorectal cancer.
abstract: OBJECTIVE
  The prognostic significance of extranodal metastasis (ENM) in colorectal cancer (CRC) is disregarded by the TNM classification system. The influence of ENM on survival among locally advanced CRC patients was examined.
  
  
  METHODS
  We reviewed retrospectively the clinical course of 263 patients who underwent surgical resection of locally advanced CRC at our Department between 2005 and 2009. We analyzed the prognostic factors with special reference to the clinicopathological factors of primary tumors.
  
  
  RESULTS
  Thirty-eight cases of ENM were detected among patients with CRC. Compared with ENM negative cancers, ENM-positive cancers were associated with poorer tumor differentiation grade (p=0.026) and higher prevalence of TNM-stage (p<0.0001), T-status (p=0.024), N-status (p<0.0001) and postoperative recurrence (p<0.0001). In univariate analysis, TNM-stage (p<0.0035), T-status (p=0.002), N-status (p<0.0024) and positive ENM (p<0.0001) were significant predictors of poor survival. Multivariate analyses showed a positive ENM to be a highly significant independent predictor of mortality (HR=1.98, 95% CI=1.23- 3.23, p=0.0053). Survival analyses using Kaplan-Meier curves demonstrated that patients with ENM-positive cancers had significantly poorer survival than patients with ENM-negative cancers. Patients with ENM-negative cancers did not show significantly different survival from patients with node-negative cancers (p=0.272, data not shown).
  
  
  CONCLUSIONS
  ENM appears to be a strong independent negative prognostic factor of poor survival in locally advanced CRC.
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan. chuchumi@showa.gunma-u.ac.jp
authors.forename: Soichi
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: Reina
authors.initials: R
authors.lastname: Watanabe
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tabe
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujii
authors.forename: Hiroki
authors.initials: H
authors.lastname: Morita
authors.forename: Wakako
authors.initials: W
authors.lastname: Kigure
authors.forename: Toshihide
authors.initials: T
authors.lastname: Kato
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Sakai
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D015179:Colorectal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome