ArticleInternational journal of colorectal disease2026
Prognostic divergence of hematogenous and lymphatic metastases in surgically treated patients with stage IV colorectal cancer.
Article in International journal of colorectal disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn patients with stage IV colorectal cancer (CRC), the prognostic impact of lymph node metastasis (LNM) remains controversial. A qualifying cohort served to explore its importance.
methodsA total of 493 eligible patients with stage IV CRC were included in this retrospective cohort study. All were surgically treated between April 2007 and December 2020 at a high-volume cancer center in Japan. Subjects were stratified by presence/absence of LNM (N+M1 vs N0M1), and propensity score matching (PSM) was done at 1:1 ratio. We then compared cancer-specific (CSS) and overall (OS) survival rates before and after PSM, using Cox regression to identify pertinent independent risk factors.
resultsPatients assigned to N+M1 and N0M1 groups totaled 384 (77.9%) and 109 (22.1%), respectively. Five-year OS proved superior for the N0M1 (vs N+M1) group, both before (41.7% vs 30.8%; p = 0.020) and after (43.7% vs 26.5%; p = 0.042) PSM. LNM also emerged as an independent prognosticator of OS in multivariate analyses conducted before (hazard ratio [HR] = 1.5, 95% confidence interval [CI]: 1.09-2.08; p = 0.014) and after (HR = 1.72, 95% CI: 1.121-2.64; p = 0.013) matching. The same was true of 5-year CSS, both before (N0M1, 46.1%; N+M1, 32.4%; p = 0.009) and after (N0M1, 48.8%; N+M1, 28.0%; p = 0.027) matching, again verifying LNM as an independent prognostic factor before (HR = 1.6, 95% CI: 1.13-2.25; p = 0.007) and after (HR = 1.86, 95% CI: 1.185-2.90; p = 0.007) PSM.
conclusionsIn patients with stage IV colorectal cancer (M1), those with distant hematogenous metastasis without regional lymph node involvement (N0M1) have a better prognosis than those with concurrent regional lymph node metastasis (N+M1). This apparent prognostic divergence must be reflected in refined tumor classification subsets.
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