title: Factors influencing apical node metastasis in colorectal cancer patients treated with laparoscopic radical resection with D3 lymphadenectomy: results from two centers in China.
abstract: OBJECTIVE
  To identify the risk factors for apical node metastasis in colorectal cancer (CRC) patients who underwent laparoscopic radical resection with D3 lymphadenectomy.
  
  
  METHODS
  The subjects were 578 consecutive patients who underwent laparoscopic radical resection with D3 lymphadenectomy for CRC between February, 2003 and December, 2009. The Cox proportional regression model was used to evaluate the association between apical node metastasis and survival and the logistic regression model was used to identify the risk factors for apical node metastasis.
  
  
  RESULTS
  Thirty patients (5.2 %) had apical node metastasis, which was an independent risk factor for poor disease-free survival [hazard ratio (HR) = 3.02, P = 0.019]. Multivariate logistic regression analysis revealed that poor differentiation [odds ratio (OR) = 4.58, P < 0.001] and ulcerative/infiltrative morphology (OR = 5.57, P = 0.023) were independent risk factors for apical node metastasis. In the subgroup analysis based on pT3-4 tumors, multivariate logistic regression analysis also suggested that these factors were significantly associated with apical node metastasis.
  
  
  CONCLUSIONS
  Apical node metastasis is an independent risk factor for poor oncologic outcome. T3-4 stage, poor differentiation, and ulcerative/infiltrative morphology are significantly associated with apical node metastasis. Notably, in this study, T1-2 stage tumors had no apical node metastasis, suggesting that D3 lymphadenectomy may be over-performed without considering the T stage of tumors.
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, North Guangzhou Road 1838, 510515, Guangzhou, China.
authors.forename: Hongyuan
authors.initials: H
authors.lastname: Chen
authors.forename: Yanan
authors.initials: Y
authors.lastname: Wang
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Hu
authors.forename: Liying
authors.initials: L
authors.lastname: Zhao
authors.forename: Guoxin
authors.initials: G
authors.lastname: Li
authors.forename: Pan
authors.initials: P
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012307:Risk Factors