{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:47:40Z","timestamp":1791830860633,"version":"4.3.4"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Surg Pathol"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extranodal extension, defined as tumor invasion beyond the lymph node capsule into perinodal adipose tissue, has been associated with adverse outcomes in several malignancies but is not included in the AJCC-TNM staging system for colorectal cancer. This study evaluated the clinicopathological and prognostic significance of extranodal extension and its extent in lymph node-positive colorectal carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty-nine patients who underwent curative-intent resection for lymph node-positive colorectal carcinoma were retrospectively analyzed. Patients were classified according to the presence of extranodal extension, and extranodal extension-positive tumors were further categorized as limited (&lt;1\u2005mm) or extensive (\u22651\u2005mm). Associations with clinicopathological variables and survival outcomes were analyzed using Cox proportional hazards regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Extranodal extension was identified in 29 patients (42%) and was associated with a higher metastatic lymph node count, higher N stage, and an increased incidence of distant metastasis (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.05). In multivariate analysis adjusted for T stage, N stage, and postoperative adjuvant chemotherapy, extranodal extension remained independently associated with shorter disease-free survival (hazard ratio 2.65; 95% confidence interval 1.10-6.38;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.031). Extranodal extension was not independently associated with overall survival. Although the extent of extranodal extension correlated with nodal burden, it was not independently associated with survival outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Extranodal extension is associated with increased nodal tumor burden and independently predicts shorter disease-free survival in colorectal carcinoma. Routine assessment and reporting of extranodal extension may improve pathological risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10668969261483649","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:32:35Z","timestamp":1791549155000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Extranodal Extension in Colorectal Cancer: Association With Nodal Burden and Disease Recurrence"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6661-1002","authenticated-orcid":false,"given":"Ezgi","family":"Hacihasanoglu","sequence":"first","affiliation":[{"name":"University of Health Sciences, Hamidiye Faculty of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysegul","family":"Isal Arslan","sequence":"additional","affiliation":[{"name":"Yeditepe University, Faculty of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4181-6753","authenticated-orcid":false,"given":"Ali Ediz","family":"Kivanc","sequence":"additional","affiliation":[{"name":"Yeditepe University, Faculty of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-88716-4"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00143-8"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.759049"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-02577-4"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-018-2309-1"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2024.01.027"},{"key":"e_1_3_2_8_2","volume-title":"AJCC cancer staging manual. 8th ed","author":"Amin MBE","year":"2017","unstructured":"Amin MBE, Stephen B, Greene FL, et al. (eds) AJCC cancer staging manual. 8th ed. Springer; 2017."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1981.00790480001001"},{"key":"e_1_3_2_10_2","unstructured":"College of American Pathologists. Protocol for the examination of specimens from patients with carcinomas of the larynx. Version 4.2.0.0. CAP. Available at: https:\/\/documents.cap.org\/protocols\/HN.Larynx_4.2.0.0.REL_CAPCP.pdf. Accessed 2026."},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e31821c4944"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/5620765"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.18223"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-020-03548-4"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tranon.2021.101190"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.SLA.0000064361.12265.9A"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-014-2488-0"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw031"},{"issue":"6","key":"e_1_3_2_19_2","first-page":"434","article-title":"Extracapsular involvement in nodal metastasis as a prognostic factor in colorectal cancer","volume":"95","author":"Bacha D","year":"2017","unstructured":"Bacha D, Mzoughi Z, Belkacem O, et al. Extracapsular involvement in nodal metastasis as a prognostic factor in colorectal cancer. Tunis Med. 2017;95(6):434-439.","journal-title":"Tunis Med"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3800791"}],"container-title":["International Journal of Surgical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10668969261483649","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10668969261483649","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10668969261483649","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:21:42Z","timestamp":1791829302000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10668969261483649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":19,"alternative-id":["10.1177\/10668969261483649"],"URL":"https:\/\/doi.org\/10.1177\/10668969261483649","relation":{},"ISSN":["1066-8969","1940-2465"],"issn-type":[{"value":"1066-8969","type":"print"},{"value":"1940-2465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"10668969261483649"}}