Incidence of apical lymph node (ALN) positivity in resectable colorectal cancer (CRC) and its prognostic significance on short term follow up at a tertiary care center in India

Abstract

Introduction: Presence of lymph node metastases in colorectal cancer (CRC) is well recognized as one of the most important prognostic factors. Almost no data is available on Apical Lymph Node (ALN) positivity and its impact on survival and recurrence in India. Our study aims to bridge this gap. Material and Methods: 40 CRC patients deemed resectable on standard preoperative work up were included in the study. Apical lymph node and specimen were sent separately for histopathological examination and patients were divided into ALN positive (ALN+) and ALN negative (ALN-) groups. Patients were followed up for a period of 24 months. All patients were followed up with 3 monthly Carcinoembryonic Antigen (CEA) and Ultrasound abdomen, colonoscopy at 1 year and Computerized tomography (CT) abdomen at 1 year. Results: Of 40 patients 8 (20%) were ALN+. 30% (12/40) had recurrences of which 100% ALN+ cases(8/8) had recurrence but only 12.5% (4/32) of ALN- group had recurrence. In ALN+ group, all recurrences were distant metastasis whereas recurrences in ALN- group were 50% local and 50% distant metastasis. Mean recurrence free survival was 6months in ALN+ group while in ALN- group it was 10.5 months. 75% of ALN+ patients had elevated CEA level compared to 18.7% of ALN- group. Lymph Node ratio (LNR) was statistically higher in ALN+ group (60% versus 2.7% in ALN- group). Conclusions: ALN positivity was found to be 20% and correlated with higher preop CEA. ALN+ status was a significant risk factor for recurrence. ALN positivity is an indicator for higher recurrence rates and distant metastasis.

Keywords

• Apical Lymph Node
• Carcinoembryonic antigen
• Circumferential Margin
• Colorectal Cancer
• Inferior mesenteric artery
• Lymph Node Ratio