Preoperative lymph-node enlargement is associated with favorable survival for patients with pathological stage II colorectal cancer.

PURPOSE: The importance of preoperative lymph-node enlargement as a prognostic factor for patients with colorectal cancer remains unclear because of inconsistent staging and size criteria. We conducted this study to evaluate its clinical impact, using a standardized definition for pathological stage II colorectal cancer. METHODS: The subjects of this retrospective study were patients with pathological stage II colorectal adenocarcinoma, who underwent curative resection between January 2009 and December 2020. Patients were categorized based on preoperative lymph-node enlargement, defined as a short-axis diameter ≥5 mm on imaging. Independent risk factors for 5-year overall survival (OS) and relapse-free survival (RFS) were investigated. RESULTS: A total of 562 patients were included (185 without and 377 with enlarged lymph nodes), and the median follow-up period was 61.8 months. Multivariate analysis identified that preoperative hemoglobin level < 12 g/dL (hazard ratios (HRs) = 1.937, 95% confidence interval (CI) = 1.181-3.175, p = 0.009) and preoperative bowel obstruction (hazard ratios (HRs) = 2.060, 95% confidence interval (CI) = 1.066-3.979, p = 0.031) were independent factors for poor OS. Conversely, lymph node enlargement was independently associated with favorable OS (HRs = 0.503, 95% CI, 0.316-0.801, p = 0.004). Pathological T4 stage was an independent factor for poor RFS (HRs = 2.973, 95% CI = 1.752-5.044, p < 0.001). CONCLUSIONS: Preoperative lymph-node enlargement predicts favorable OS for patients with pathological stage II colorectal cancer.