Patient Selection Matters: Prognostic Determinants in Stage IV Colorectal Cancer With Isolated Non-Regional Lymph...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Colorectal cancer (CRC) with isolated non-regional lymph node metastasis (INRLNM) is rare (<1% of metastatic cases).
• Systemic therapy is standard, but the role of surgery is debated.
• This study investigates palliative surgery and treatment sequencing impacts on prognosis.

Purpose of the Study:

• To evaluate the impact of palliative surgery on survival for stage IV CRC with INRLNM.
• To assess the influence of treatment sequencing (surgery-first vs. neoadjuvant chemotherapy) on patient outcomes.
• To identify prognostic factors in this specific metastatic pattern.

Main Methods:

• Retrospective analysis of 50 stage IV CRC patients with INRLNM.
• Comparison of chemotherapy-alone (CA) versus surgery groups (surgery-first or neoadjuvant chemotherapy).
• Kaplan-Meier and Cox regression analyses for overall survival (OS) and progression-free survival (PFS).

Main Results:

• Kaplan-Meier analysis showed superior OS and PFS in the surgery group vs. CA group (P < .05).
• Multivariate Cox regression indicated surgery was not an independent predictor of survival.
• ASA grade III, right-sided cancer, and surgical complications were independently linked to worse outcomes.

Conclusions:

• Surgical intervention alone was not independently associated with improved survival in stage IV CRC with INRLNM.
• Neoadjuvant chemotherapy followed by surgery may offer a survival trend benefit.
• Larger studies are needed to define optimal treatment strategies for this rare presentation.