# Poor prognosis in stage III colorectal cancer with apical lymph node metastasis: a single-center retrospective study

## TL;DR

This study shows that apical lymph node metastasis in stage III colorectal cancer is linked to worse outcomes, suggesting it should be considered in prognosis.

## Contribution

The study identifies apical lymph node metastasis as an independent adverse prognostic factor beyond the current pN staging in CRC.

## Key findings

- ALN-positive patients had significantly higher local and systemic recurrence rates.
- Overall survival was significantly shorter in patients with ALN metastasis.
- ALN status was an independent predictor of worse survival in multivariate analysis.

## Abstract

The impact of apical lymph node (ALN) status on the prognosis of colorectal cancer (CRC) remains controversial, and ALN status is not included in the current Tumor Node Metastasis (TNM) staging system. This study aimed to evaluate the effect of ALN status on recurrence and survival rates. In this retrospective study, 117 stage 3 CRC patients aged over 18 who underwent surgery between 2015 and 2024 and had their ALN status determined were evaluated. Patients with metastatic disease at diagnosis, those with undetermined ALN status, and those with concurrent malignancies were excluded. Patients were analyzed based on demographic, clinical, pathological, and survival data. The median age was 61 years (range: 33–83), and 60.7% of the patients were male. The pN stage was significantly more advanced (p < 0.001) and the number of metastatic lymph nodes was significantly higher (p = 0.003) in the ALN ( +) group. During a median follow-up of 46 months, 14 local recurrences, 31 systemic recurrences, and 27 cancer-related deaths were observed. Local recurrence, systemic recurrence, and cancer-related deaths were significantly more frequent in the ALN ( +) group (p = 0.027, p < 0.001, and p < 0.001, respectively). Locoregional disease-free survival, systemic disease-free survival and overall survival were significantly shorter in the ALN ( +) group (p = 0.011, p < 0.001, and p < 0.001, respectively). In multivariate analysis, SDFS and OS were found to be significantly shorter in the ALN ( +) and pN2 groups. ALN metastasis can be considered as an additional adverse prognostic factor in CRC beyond the pN stage.