{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T01:39:17Z","timestamp":1790386757327,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0536500"],"award-info":[{"award-number":["2024ZD0536500"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["7254408"],"award-info":[{"award-number":["7254408"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024-I2M-C&T-B-051"],"award-info":[{"award-number":["2024-I2M-C&T-B-051"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["CFA202503009"],"award-info":[{"award-number":["CFA202503009"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["CFA202502001"],"award-info":[{"award-number":["CFA202502001"]}]},{"DOI":"10.13039\/501100004826","name":"Beijing Natural Science Foundation","doi-asserted-by":"publisher","award":["2024ZD0536500"],"award-info":[{"award-number":["2024ZD0536500"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004826","name":"Beijing Natural Science Foundation","doi-asserted-by":"publisher","award":["7254408"],"award-info":[{"award-number":["7254408"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004826","name":"Beijing Natural Science Foundation","doi-asserted-by":"publisher","award":["2024-I2M-C&T-B-051"],"award-info":[{"award-number":["2024-I2M-C&T-B-051"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004826","name":"Beijing Natural Science Foundation","doi-asserted-by":"publisher","award":["CFA202503009"],"award-info":[{"award-number":["CFA202503009"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004826","name":"Beijing Natural Science Foundation","doi-asserted-by":"publisher","award":["CFA202502001"],"award-info":[{"award-number":["CFA202502001"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["2024ZD0536500"],"award-info":[{"award-number":["2024ZD0536500"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["7254408"],"award-info":[{"award-number":["7254408"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["2024-I2M-C&T-B-051"],"award-info":[{"award-number":["2024-I2M-C&T-B-051"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["CFA202503009"],"award-info":[{"award-number":["CFA202503009"]}]},{"name":"CAMS Innovation Fund for Medical Sciences (CIFMS)","award":["CFA202502001"],"award-info":[{"award-number":["CFA202502001"]}]},{"name":"National High Level Hospital Clinical Research Funding, Cooperation Fund of CHCAMS Beijing &amp; Langfang &amp; SZCH","award":["2024ZD0536500"],"award-info":[{"award-number":["2024ZD0536500"]}]},{"name":"National High Level Hospital Clinical Research Funding, Cooperation Fund of CHCAMS Beijing &amp; Langfang &amp; SZCH","award":["7254408"],"award-info":[{"award-number":["7254408"]}]},{"name":"National High Level Hospital Clinical Research Funding, Cooperation Fund of CHCAMS Beijing &amp; Langfang &amp; SZCH","award":["2024-I2M-C&T-B-051"],"award-info":[{"award-number":["2024-I2M-C&T-B-051"]}]},{"name":"National High Level Hospital Clinical Research Funding, Cooperation Fund of CHCAMS Beijing &amp; Langfang &amp; SZCH","award":["CFA202503009"],"award-info":[{"award-number":["CFA202503009"]}]},{"name":"National High Level Hospital Clinical Research Funding, Cooperation Fund of CHCAMS Beijing &amp; Langfang &amp; SZCH","award":["CFA202502001"],"award-info":[{"award-number":["CFA202502001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: The metastatic patterns of apical lymph node (ALN) in rectal and sigmoid colon cancer are currently unclear, and there is no consensus on the indications for dissection of ALN. This study aimed to analyze the impact of ALN metastasis on prognosis, determine the metastatic patterns of ALN and provide evidence for indications of ALN dissection in rectal and sigmoid colon cancer. Methods: In this multicenter, retrospective cohort study, patients from five centers with stage I-III rectal or sigmoid colon cancer who underwent laparoscopic radical surgery with ALN dissection without neoadjuvant treatment from January 2015 to December 2019 were enrolled. Results: Among 2809 patients, the positive rate of ALN was 1.9%. The 5-year overall survival and cancer-specific survival rate for patients with metastatic ALN were 37.5% and 41.0%, respectively. ALN metastasis was the independent risk factor for poor prognosis. Tumor size \u22655 cm (OR = 2.32, 95% CI: 1.30\u20134.13, p = 0.004), signet ring cell cancer\/mucinous adenocarcinoma (vs. poor differentiated adenocarcinoma, OR = 0.19, 95% CI: 0.08\u20130.45, p &lt; 0.001; vs. moderate to well differentiated adenocarcinoma, OR = 0.22, 95% CI: 0.11\u20130.42, p &lt; 0.001), T4 stage (OR = 1.93, 95% CI: 1.05\u20133.55, p = 0.034), N2 stage (OR = 8.86, 95% CI: 4.45\u201317.65, p &lt; 0.001) and radiologic evidence of extramural venous invasion (OR = 1.88, 95% CI: 1.03\u20133.42, p = 0.040) were independent risk factors for ALN metastasis. The nomogram model developed by these factors achieved a good predictive performance. Conclusions: This research offered insights into the incidence, risk factors, and prognostic significance of apical lymph node metastasis in cases of rectal and sigmoid colon cancer. Additionally, the study furnished empirical support for the criteria guiding ALN dissection. Furthermore, a pragmatic risk assessment model was developed to predict ALN metastasis.<\/jats:p>","DOI":"10.3390\/cancers17142389","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T13:33:27Z","timestamp":1752845607000},"page":"2389","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Metastatic Patterns of Apical Lymph Node and Prognostic Analysis in Rectal and Sigmoid Colon Cancer\u2014A Multicenter Retrospective Cohort Study of 2809 Cases"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9033-1000","authenticated-orcid":false,"given":"Mingguang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuqiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiwen","family":"Wu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Cancer, Peking University Cancer Hospital and Institute, Beijing 100142, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Du","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Medical Center, Chinese Peoples\u2019 Liberation Army General Hospital, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiwen","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangze","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shidong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Medical Center, Chinese Peoples\u2019 Liberation Army General Hospital, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinzhi","family":"Liu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Cancer, Peking University Cancer Hospital and Institute, Beijing 100142, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xishan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Chinese Apical Lymph Node Study Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.1038\/s41467-020-15886-6","article-title":"Mapping the spreading routes of lymphatic metastases in human colorectal cancer","volume":"11","author":"Zhang","year":"2020","journal-title":"Nat. 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