Research Papers: Pathology:

Limited effect of lymph node status on the metastatic pattern in colorectal cancer

Nikki Knijn, Felice N. van Erning, Lucy I.H. Overbeek, Cornelis J.A. Punt, Valery E.P.P. Lemmens, Niek Hugen and Iris D. Nagtegaal _

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Oncotarget. 2016; 7:31699-31707. https://doi.org/10.18632/oncotarget.9064

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Nikki Knijn1, Felice N. van Erning2,3, Lucy I.H. Overbeek4, Cornelis J.A. Punt5, Valery E.P.P. Lemmens2,3, Niek Hugen6 and Iris D. Nagtegaal1

1 Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands

2 Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands

3 Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

4 PALGA Foundation, Houten, The Netherlands

5 Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

6 Department of Surgery, Radboud University Medical Centerl, Nijmegen, The Netherlands

Correspondence to:

Iris D. Nagtegaal, email:

Keywords: colorectal neoplasms, neoplasm metastasis, lymph nodes, blood vessels, autopsy, Pathology Section

Received: February 09, 2016 Accepted: April 05, 2016 Published: April 27, 2016


Regional lymph node metastases in colorectal cancer (CRC) decrease outcome. Whether nodal metastases function as a biomarker, i.e. as a sign of advanced disease, or are in fact involved in the metastatic process is unclear. We evaluated metastatic patterns of CRC according to the lymph node status of the primary tumor.

A retrospective review of 1393 patients with metastatic CRC who underwent autopsy in the Netherlands was performed. Metastatic patterns of regional lymph node positive and negative CRC were compared and validated by population-based data from the Eindhoven Cancer Registry (ECR).

Patients with regional lymph node positive CRC more often developed peritoneal metastases (28% vs. 21%, p=0.003) and distant lymph node metastases (25% vs. 15%, p <0.001). Incidences of liver and lung metastases were comparable. Data from the ECR confirmed our findings regarding peritoneal (22.4% vs. 17.0%, p=0.003) and distant lymph node metastases (15.8% vs. 9.7%, p <0.001).

Regional lymph node positive CRC show a slightly different dissemination pattern, with higher rates of peritoneal and distant lymph nodes metastases. Comparable incidences of liver and lung metastases support the hypothesis that dissemination to distant organs occurs independently of lymphatic spread.

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