Adequacy of Lymph Node Staging in Colorectal Cancer: Analysis of 250 Patients and Analytical Literature Review

Ghahramani, Leila; Razzaghi, Samira; Mohammadianpanah, Μohammad; Pourahmad, Saeedeh

doi:10.5812/acr.11495

Cited by 7 publications

(11 citation statements)

References 60 publications

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“…In addition, inadequate lymph nodes examination can indirectly underestimate node staging, which leads to classification of patients with real stage III colorectal cancer as stage I or II disease incorrectly. Subsequently, some patients with stage III are deprived from optimal treatments (8,13).…”

Section: Discussionmentioning

confidence: 99%

“…However, inadequate lymph nodes evaluation is a common problem in colorectal cancer and a high proportion of patients had a limited number of lymph nodes examined (7). According to two recent studies performed in our country, only a third of the patients with colorectal cancer underwent adequate lymph nodes examination (8,9). These evidences point out that a potential risk of understaging is present in these patients.…”

Section: Introductionmentioning

confidence: 93%

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Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer

et al. 2013

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Background:The extent of lymph node involvement is the most significant prognostic indicator in resected locoregional colorectal cancer. Objectives: This study aimed to investigate the prognostic value of total lymph nodes identified and ratio of lymph nodes in resected colorectal cancer. Patients and Methods: Two hundred seventy five patients with histologically proven resected locoregional invasive colorectal adenocarcinoma from 2003 to 2011 were included. All patients were treated with standard surgical resection for their colorectal cancer. Patients with incomplete data, or unresectable tumors or distant metastases were excluded from the study. All potential prognostic variables were evaluated for their impact on the local control, disease-free, and overall survival rates. Results: Of the 275 patients, 162 were men and 113 were women with a median age of 54 (range 23-84) years. The mean total lymph nodes were significantly higher in colon cancer than rectal cancer (11 versus 7.5, P = 0.001). In node positive (stage III) patients, the mean lymph nodes ratio was 0.5 for rectal cancers and 0.37 for colon cancers respectively showing a nonsignificant (P = 0.05) trend toward higher lymph nodes ratio in rectal cancer patients. In univariate analysis, the mean total number of lymph node identified was a prognostic factor for 5-year disease free (P = 0.04) and overall survival (P = 0.02) rates. In node positive patients, lymph nodes ratio was a prognostic factor for 5-year local control (P = 0.04), disease free survival (P = 0.01), and overall survival (P = 0.01) rates. On multivariate analysis, advanced primary tumor stage, rectal primary site and the presence of perineural invasion were independent adverse prognostic factors for overall survival. Conclusions: Total lymph nodes identified and ratio of lymph nodes are associated with oncological outcomes outcomes in patients with colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer

et al. 2013

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“…In addition, age, tumor grade and differentiation, mucinous subtype, geographic region, total lymph node harvested, and lymph node ratio were found as prognostic factors for overall survival in the patients with colorectal cancer (7,10,13). There are some concerns regarding the adequacy of lymph node staging as well as different patterns of clinical and pathological features and outcomes of Iranian patients with colorectal cancer compared to other parts of the world (13)(14)(15)(16)(17).…”

Section: Contextmentioning

confidence: 99%

An Overview of Clinical and Pathological Characteristics and Survival Rate of Colorectal Cancer in Iran

Hoseini¹,

Moaddabshoar²,

Hemati³

et al. 2014

Ann Colorectal Res

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Context:Colorectal cancer is one of the most common cancers and the leading cause of cancer death in Iran. This study aimed to identify the clinical and pathological characteristics, as well as survival rate of colorectal cancer in Iran. Evidence Acquisition: The articles published in PubMed without language and time restrictions were included in this review. Only original clinical articles were included in the review and non-clinical studies, including cellular, molecular, genetics, and animal reports, were excluded. The case reports, letters, reviews, and clinical reports with less than 100 patients were excluded, as well. All the clinical data regarding the patients' demographics, tumor characteristics, and survival rate were collected. Results: A total of 178 studies were identified at the initial step of literature search. After applying the inclusion and exclusion criteria, 27 studies, including 37901 patients were eligible. The mean age of the patients was 57.2 years, and the male-female ratio was 1.38. Colon, rectum, and rectosigmoid junction accounted for 58%, 28%, and 14% of all colorectal primary sites, respectively. Moreover, the average proportion of the patients with stages 0-I, II, III, and IV was 9%, 39%, 36%, and 16%, respectively. Besides, tumor grades 1, 2, and 3 were reported in 52%, 37%, and 11% of the patients, respectively. Adenocarcinoma (96.8%) was the most frequent histological type. The mean and median survival rate was 80.1 and 55.2 months, respectively. Additionally, the average 5-year overall survival rate was 52.5%. Conclusions: In Iran, colorectal cancer tends to manifest at locally advanced stage with poor prognosis. Therefore, public health strategies, such as screening programs, should be planned for early detection of this aggressive neoplasm.

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“…Evaluation of at least 12 lymph nodes is currently considered as an adequate node staging in colorectal cancer [4]. However, despite advances in colorectal surgery, inadequate lymph nodes examination remains a common practice in resected colorectal cancer [5,6]. This pitfall is more prominent in the rectal location, particularly in cases receiving neoadjuvant chemoradiation [5,7].…”

Section: Editorialmentioning

confidence: 99%

Staging Accuracy in Colorectal Cancer: A Pathologic and Therapeutic Dilemma

Mohammadianpanah¹

2014

JCPCR

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Adequacy of Lymph Node Staging in Colorectal Cancer: Analysis of 250 Patients and Analytical Literature Review

Cited by 7 publications

References 60 publications

Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer

Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer

An Overview of Clinical and Pathological Characteristics and Survival Rate of Colorectal Cancer in Iran

Staging Accuracy in Colorectal Cancer: A Pathologic and Therapeutic Dilemma

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