Evaluation of the prognostic relevance of the recommended minimum number of lymph nodes in colorectal cancer—a propensity score analysis

Ramser, Michaela; Lobbes, Leonard A.; Warschkow, René; Viehl, Carsten T.; Lauscher, Johannes C.; Droeser, Raoul A.; Kettelhack, Christoph; Weixler, Benjamin

doi:10.1007/s00384-021-03835-8

Cited by 5 publications

(5 citation statements)

References 47 publications

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“…Consistent with our results, Ramser et al also found that the number of nodes examined was an independent predictor of CC prognosis. Detecting more than or equal to 12 lymph nodes could improve the prognosis of patients with CC, indicating that too few nodes examined was associated with a poor prognosis, especially in patients with grade II tumors ( 32 ). Clinically, fewer nodes examined could result in an inaccurate pathological assessment, which might influence subsequent adjuvant therapy, and further affect prognosis.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a survival prediction model for 113,239 patients with colon cancer: a retrospective cohort study

Liu¹,

Lai²,

Yang³

et al. 2022

J Gastrointest Oncol

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Background: Colon cancer (CC) is the third most commonly diagnosed malignant tumor and remains the second leading cause of cancer-related deaths worldwide. However, the risk assessment of poor prognosis of CC is limited in previous studies. This study aimed to develop a predictive nomogram for the survival of CC patients. Methods:In this retrospective cohort study, 113,239 CC patients from the Surveillance, Epidemiology, and End Results (SEER) database were randomly divided into training (n=56,619) and testing (n=56,620) sets with a ratio of 1:1. Demographic, clinical data and survival status of patients were extracted. The outcomes were 3-and 5-year survival of CC. Univariate and multivariate Cox regression analyses were used to screen the predictors to develop the predictive nomogram. Internal validation and stratified analyses were further assessed the nomogram. The C-index and area under the curve (AUC) were calculated to estimate the model's predictive capacity, and calibration curves were adopted to estimate the model fit.Results: Totally 38,522 (34.02%) patients died during the 5-year follow-up. The nomogram incorporated variables associated with the prognosis of CC patients, including age, gender, marital status, insurance status, tumor grade, stage (T/N/M), surgery, and number of nodes examined, with a C-index of 0.775 in the training set and 0.774 in the testing set. The AUCs of the nomogram for the 3-and 5-year survival prediction in the training set were 0.817 and 0.808, with the sensitivity of 0.688 and 0.716, and the specificity of 0.785 and 0.740, respectively. Similar results were found in the testing set. The C-index of the predictive nomogram for male, female, White, Black, and other races was 0.769, 0.779, 0.773, 0.770, and 0.770, respectively. The calibration curves for the nomogram in the above five cohorts showed a good agreement between actual and predicted values. Conclusions:The nomogram may exhibit a certain predictive performance based on the SEER database, which may provide individual survival predictions for CC patients.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a survival prediction model for 113,239 patients with colon cancer: a retrospective cohort study

Liu¹,

Lai²,

Yang³

et al. 2022

J Gastrointest Oncol

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“…Despite this heterogeneity, the criteria for the optimal number of lymph nodes to be dissected have not changed in less than half a century and do not consider tumor localization. Previous studies on lymph node count and survival are limited because they do not take tumor localization into account 8–12 …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies on lymph node count and survival are limited because they do not take tumor localization into account. [8][9][10][11][12] Moreover, the use of minimally invasive surgery for colorectal cancer has increased dramatically over the past 20 years, prompting a shift toward laparoscopic surgery from open surgery. 13 Therefore, we conducted a multicenter study to determine the prognostic impact of lymph node yield based on tumor location in patients with stage II CC who underwent laparoscopic surgery.…”

mentioning

confidence: 99%

True significance of the number of retrieved lymph nodes in stage II colon cancer resected by minimally invasive surgery: Influence of tumor sidedness

Iguchi,

Sugiyama,

Mushiake

et al. 2024

Asian J Endoscop Surgery

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BackgroundIn patients with stage II colon cancer (CC) undergoing minimally invasive surgery, the association between the clinical significance of lymph node yield and tumor localization remains unknown. We aimed to determine the optimal number of lymph nodes to be retrieved based on tumor localization in patients with stage II CC undergoing minimally invasive surgery.MethodsThis was a multicenter retrospective study. Overall, 263 patients with stage II CC who underwent laparoscopic surgery between January 1, 2008 and December 31 were enrolled. The primary outcome was the optimal number of lymph nodes retrieved based on tumor localization.ResultsThe median number of retrieved lymph nodes was 30 and 26 in the right‐(n = 125) and left‐sided (n = 138) CC groups, respectively (p = .0007). Inadequate dissection (<12 nodes) occurred in 4.2% of patients: 1.6% in the right‐sided CC group and 6.5% in the left‐sided CC group. Multivariate Cox regression analysis showed a decreasing trend in adjusted hazard ratios with increasing nodes, with an optimal cutoff of 15 lymph nodes in the left‐sided CC group (adjusted hazard ratio, 5.868; 95% confidence interval, 1.247–27.62; p = .02). Lymph node yield was not independently associated with survival in the right‐sided CC group.ConclusionsFor patients with left‐sided stage II CC undergoing laparoscopic surgery, aiming for at least 15 retrieved lymph nodes may be optimal for accurate staging and prognostic assessment. The optimal lymph node yield likely varies based on tumor location, requiring further investigation in right‐sided CC.

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“…been introduced to open and laparoscopic CME for colon cancer surgery in 2011 and 2013, respectively, we felt that a standardized video-based educational programme, including 3D video animations and cadaveric dissections, would help standardize the technique. A learning curve analysis was performed considering the total number of lymph nodes retrieved, which is a crucial quality marker in colon cancer surgery[13][14][15]. In a prospective study the survival rates improved as the number of the lymph nodes retrieved increased in Stage III colon cancer[14].…”

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confidence: 99%

Computer‐based multimodal training module facilitates standardization of complete mesocolic excision technique for right‐sided colon cancer: Long‐term oncological outcomes

et al. 2021

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Aim:The aim of this study is to demonstrate our video training tool developed to teach and standardize complete mesocolic excision (CME) for right-sided colon cancer and also to present our long-term oncological outcomes. Method: Educational narrative videos were produced to demonstrate the technical steps of CME. First, a three-dimensional animation video was prepared. Then cadaveric dissections were recorded in a step-by-step fashion, following the sequences of open and minimally invasive surgery. These were followed by videos of real-life demonstrations of surgical procedures, enhanced by superimposed animations of key anatomical structures. In order to demonstrate the impact of this training module on outcomes of patients undergoing CME, we retrospectively queried data from before (2005-2010) and after (2011-2019) implementation of standardized CME in our practice. Results: A total of 180 consecutive patients underwent right hemicolectomy between 2005 and 2019. Fifty-four patients underwent surgery before and 126 patients after CME principles were elaborated and standardized. Of those patients who had surgery after the training module, 58 (46%) underwent open surgery and 68 (54%) underwent laparoscopic colectomy. Demographics, perioperative parameters and morbidity werecomparable between the groups. The 5-year overall and disease-free survival rates were significantly improved after implementation of CME training (p = 0.059 and p = 0.041, respectively). Also, 5-year overall and disease-free survival rates for all patients were considerably better than our reported national outcomes. Conclusion: Our comprehensive step-by-step training video module for the CME technique demonstrates surgical anatomical planes and important vascular structures and variations. The video also helps standardization of the CME technique and should contribute to improved histopathological and oncological outcomes.

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Evaluation of the prognostic relevance of the recommended minimum number of lymph nodes in colorectal cancer—a propensity score analysis

Cited by 5 publications

References 47 publications

Development and validation of a survival prediction model for 113,239 patients with colon cancer: a retrospective cohort study

Development and validation of a survival prediction model for 113,239 patients with colon cancer: a retrospective cohort study

True significance of the number of retrieved lymph nodes in stage II colon cancer resected by minimally invasive surgery: Influence of tumor sidedness

Computer‐based multimodal training module facilitates standardization of complete mesocolic excision technique for right‐sided colon cancer: Long‐term oncological outcomes

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