title: Metachronous metastasis- and survival-analysis show prognostic importance of lymphadenectomy for colon carcinomas.
abstract: BACKGROUND
  Lymphadenectomy is performed to assess patient prognosis and to prevent metastasizing. Recently, it was questioned whether lymph node metastases were capable of metastasizing and therefore, if lymphadenectomy was still adequate. We evaluated whether the nodal status impacts on the occurrence of distant metastases by analyzing a highly selected cohort of colon cancer patients.
  
  
  METHODS
  1,395 patients underwent surgery exclusively for colon cancer at the University of Lübeck between 01/1993 and 12/2008. The following exclusion criteria were applied: synchronous metastasis, R1-resection, prior/synchronous second carcinoma, age < 50 years, positive family history, inflammatory bowel disease, FAP, HNPCC, and follow-up < 5 years. The remaining 421 patients were divided into groups with (TM+, n = 75) or without (TM-, n = 346) the occurrence of metastasis throughout a 5-year follow-up.
  
  
  RESULTS
  Five-year survival rates for TM + and TM- were 21% and 73%, respectively (p < 0.0001). Survival rates differed significantly for N0 vs. N2, grading 2 vs. 3, UICC-I vs. -II and UICC-I vs. -III (p < 0.05). Regression analysis revealed higher age upon diagnosis, increasing N- and increasing T-category to significantly impact on recurrence free survival while increasing N-and T-category were significant parameters for the risk to develop metastases within 5-years after surgery (HR 1.97 and 1.78; p < 0.0001).
  
  
  CONCLUSIONS
  Besides a higher T-category, a positive N-stage independently implies a higher probability to develop distant metastases and correlates with poor survival. Our data thus show a prognostic relevance of lymphadenectomy which should therefore be retained until conclusive studies suggest the unimportance of lmyphadenectomy.
authors.affiliation: Department of Surgery, Laboratory for Surgical Research, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. tlaubert@googlemail.com
authors.forename: Tilman
authors.initials: T
authors.lastname: Laubert
authors.forename: Jens K
authors.initials: JK
authors.lastname: Habermann
authors.forename: Claudia
authors.initials: C
authors.lastname: Hemmelmann
authors.forename: Markus
authors.initials: M
authors.lastname: Kleemann
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Oevermann
authors.forename: Ralf
authors.initials: R
authors.lastname: Bouchard
authors.forename: Philipp
authors.initials: P
authors.lastname: Hildebrand
authors.forename: Thomas
authors.initials: T
authors.lastname: Jungbluth
authors.forename: Conny
authors.initials: C
authors.lastname: Bürk
authors.forename: Hamed
authors.initials: H
authors.lastname: Esnaashari
authors.forename: Erik
authors.initials: E
authors.lastname: Schlöricke
authors.forename: Martin
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Ziegler
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Bruch
authors.forename: Uwe J
authors.initials: UJ
authors.lastname: Roblick
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D015996:Survival Rate; D013997:Time Factors