Clinico‐pathological factors influencing lymph node yield in colorectal cancer and impact on survival: Analysis of new zealand cancer registry data

Abstract

LNY is influenced by patient age, site of disease and T stage. LNY (Stage I-II) and LNR (Stage III-IV) have independent prognostic value in CRC.

Mesocolic Lymph Node Number, Size, and Density

“…lymph node yield has been shown to be an independent prognostic indicator in colon cancer with a higher lnY resulting in improved survival regardless of the stage of the disease or the presence of ln metastases. 4,5,[32][33][34] this correlation between lnY and improved survival is poorly understood. one contributing factor may be stage migration (also known as the "Will Rogers phenomenon") whereby increasing the number of lns examined increases the likelihood of identifying ln metastases.…”

“…2,5,[12][13][14][15][16] one such factor is the site of disease, with right-sided disease having a higher lnY than left-sided disease. 5,17 this may be related, in part, to the greater length of right-sided surgical resections 18 and/or more immunogenic right-sided tumors. 19 however, there may be fundamental anatomical differences between the number, density, and morphology of lns in the right and left mesocolons.…”

“…3 more recently, the lymph node yield (lnY) in a surgical specimen has been found to be an independent prognostic factor in patients with CRC for reasons that remain poorly understood. 4,5 in 1991, the World Congress of Gastroenterology recommended removal and examination of at least 12 lns to prevent understaging of CRC, 6 a figure that has since been reiterated in numerous international guidelines. [7][8][9][10][11] Consequently, several population studies have investigated factors that influence lnY.…”

“…[7][8][9][10][11] Consequently, several population studies have investigated factors that influence lnY. 2,5,[12][13][14][15][16] one such factor is the site of disease, with right-sided disease having a higher lnY than left-sided disease. 5,17 this may be related, in part, to the greater length of right-sided surgical resections 18 and/or more immunogenic right-sided tumors.…”

Log odds of positive lymph nodes is superior to the number- and ratio-based lymph node classification systems for colorectal cancer patients undergoing curative (R0) resection

“…According to the guidelines of the AJCC/UICC, a minimum of 12 lymph nodes must be resected and assessed to adequately evaluate lymph node status. The positive nodes category (pN), which is based on the number of involved lymph nodes, may be affected by the adequacy of the lymph nodes retrieved or examined (5) and it is affected by age, site of disease, T stage, extensiveness of lymphadenectomy performed by the surgeon and diligence of the pathologist (6)(7)(8). Unfortunately, despite the AJCC recommendation stating that ≥12 lymph nodes must be examined, the median number of examined lymph nodes was low, ranging between 6 and 13 (9).…”