Clinically important aspects of lymph node assessment in colon cancer

Wright, Frances C.; Law, Calvin; Berry, Scott; Smith, Andrew

doi:10.1002/jso.21226

Cited by 57 publications

(49 citation statements)

References 58 publications

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“…A probable proxy for thoroughness of colon cancer care (effective staging and treatment), lymph node evaluation depends on the expertise of both surgeons and pathologists. [47][48][49] Patients with surgically resected stage II or III colon cancer are the most likely to benefit from valid staging and adjuvant chemotherapies; in this group, lower income was associated with less thorough lymph node evaluation in San Francisco but not in Toronto. Among highincome patients, however, lymph node evaluation was more thorough in San Francisco than in Toronto.…”

Section: Depiction Of Two-and Three-way Interactionsmentioning

confidence: 99%

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

Gorey¹,

Luginaah²,

Bartfay³

et al. 2011

Am J Public Health

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Objectives-We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California.Methods-We analyzed registry data for colon cancer patients from Ontario (n=930) and California (n=1014), diagnosed between 1996 and 2000 and followed until 2006, on stage, surgery, adjuvant chemotherapy, and survival. We obtained socioeconomic data for individuals' residences from population censuses.Correspondence should be sent to Kevin Gorey, School of Social Work, University of Windsor, 401 Sunset Ave, Windsor, Ontario, N9B 3P4 gorey@uwindsor.ca. Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. ContributorsK. M. Gorey conceptualized and supervised the study and led the writing. K. Y. Fung led the analysis. All authors assisted with study design, data analysis, and interpretation and writing. Human Participant Protection CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptResults-Income was directly associated with lymph node evaluation, chemotherapy, and survival in San Francisco but not in Toronto. High-income persons had better survival rates in San Francisco than in Toronto. After adjustment for stage, survival was better for low-income residents of Toronto than for those of San Francisco. Middle-to low-income patients were more likely to receive indicated chemotherapy in Toronto than in San Francisco.Conclusions-Socioeconomic factors appear to mediate colon cancer care in urban areas of the United States but not in Canada. Improvements are needed in screening, diagnostic investigations, and treatment access among low-income Americans.A study of cancer survival in low-income areas of Toronto, Ontario, and Detroit, Michigan, during the 1980s found advantages among Canadians for common cancers. 1 The Toronto survival advantage was replicated for breast cancer across diverse low-income Canadian and US contexts through the 1990s. 2 Studies of that era, however, were not able to account for differences in stage of disease at diagnosis. More recent studies that accounted for breast cancer stage again found Canadian advantages. [3][4][5][6] In the United States, women with breast cancer who lived in low-income areas waited longer for surgery and adjuvant radiation therapy and were less likely to receive radiation therapy or to survive. Similar disparities between high-and low-income women with breast cancer did not exist in Canada; thus lowincome Canadians fared better across most breast cancer care indices than their US counterparts. More inclusive health insurance in Canada was advanced as the most plausible explanation.Colon cancer care may be an even more important health care performance indicator. The second most frequent cause of cancer death in North America, its prognosis can be excellent with early diagnosis and treatment. 7,8 For several reasons, colon cancer seems particularly instructive for Canada-US cancer care comparisons. First, research on income and colon cancer survi...

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Section: Depiction Of Two-and Three-way Interactionsmentioning

confidence: 99%

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

Gorey¹,

Luginaah²,

Bartfay³

et al. 2011

Am J Public Health

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“…These studies have shown that higher lymph node yield is associated with better survival after colon cancer surgery [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

No change in lymph node positivity rate despite increased lymph node yield and improved survival in colon cancer

Erning

Crolla

Rutten

et al. 2014

European Journal of Cancer

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“…The recommended number of nodes for appropriate staging is a minimum of 12 (5), although this goal has been achieved in as low as 50% of the patients (6). Factors associated with either a poor (<12 nodes) or adequate (≥12 nodes) LN harvest is the subject of extensive debate (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Influence of Microsatellite Instability and KRAS and BRAF Mutations on Lymph Node Harvest in Stage I–III Colon Cancers

Berg

Guriby

Nordgård

et al. 2013

Mol Med

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Lymph node (LN) harvest is influenced by several factors, including tumor genetics. Microsatellite instability (MSI) is associated with improved node harvest, but the association to other genetic factors is largely unknown. Research methods included a prospective series of stage I-III colon cancer patients undergoing ex vivo sentinel-node sampling. The presence of MSI, KRAS mutations in codons 12 and 13, and BRAF V600E mutations was analyzed. Uni-and multivariate regression models for node sampling were adjusted for clinical, pathological and molecular features. Of 204 patients, 67% had an adequate harvest (≥12 nodes). Adequate harvest was highest in patients whose tumors exhibited MSI (79%; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.2-4.9; P = 0.007) or were located in the proximal colon (73%; 2.8, 1.5-5.3; P = 0.002). In multiple linear regression, MSI was a significant predictor of the total LN count (P = 0.02). Total node count was highest for cancers with MSI and no KRAS/BRAF mutations. The independent association between MSI and a high LN count persisted for stage I and II cancers (P = 0.04). Tumor location in the proximal colon was the only significant predictor of an adequate LN harvest (adjusted OR 2.4, 95% CI 1.2-4.9; P = 0.01). An increase in the total number of nodes harvested was not associated with an increase in nodal metastasis. In conclusion, number of nodes harvested is highest for cancers of the proximal colon and with MSI. The nodal harvest associated with MSI is influenced by BRAF and KRAS genotypes, even for cancers of proximal location. Mechanisms behind the molecular diversity and node yield should be further explored.

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Clinically important aspects of lymph node assessment in colon cancer

Cited by 57 publications

References 58 publications

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

No change in lymph node positivity rate despite increased lymph node yield and improved survival in colon cancer

Influence of Microsatellite Instability and KRAS and BRAF Mutations on Lymph Node Harvest in Stage I–III Colon Cancers

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