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

BackgroundColorectal cancer (CRC) with isolated non-regional lymph node metastasis (INRLNM) is a rare entity, accounting for <1% of metastatic cases. While systemic therapy is the standard treatment, the benefit of surgical intervention remains controversial. Consequently, this retrospective study evaluates the impact of palliative surgery and treatment sequencing on patient prognosis.MethodsFifty patients diagnosed with stage IV CRC and INRLNM were included. Patients were further categorized into treatment subgroups, including chemotherapy-alone (CA), best supportive care, and a surgery group. The surgery group was subdivided into surgery-first (SF) and neoadjuvant chemotherapy subgroups with or without lymph node regression. Overall survival (OS) and progression-free survival (PFS) were evaluated using Kaplan-Meier analyses and Cox proportional hazards models.ResultsWhile Kaplan-Meier analyses indicated superior OS and PFS in the surgery group compared to the CA group (P < .05), multivariate Cox regression revealed that surgical intervention was not an independent predictor of survival. Subgroup analyses showed no survival differences based on neoadjuvant chemotherapy sequencing or lymph node regression. Instead, ASA grade III, right-sided cancer, and surgical complications were independently associated with worse outcomes.DiscussionSurgical intervention was not independently associated with a survival benefit in this patient population. However, our findings suggest that neoadjuvant chemotherapy followed by surgery may exhibit a more favorable trend in overall survival. Given the rarity of this metastatic pattern, further large-scale studies are essential to clarify and establish optimal treatment strategies for these patients.