Improving Nodal Harvest in Colorectal Cancer: So What?

Porter, Geoffrey A.; Urquhart, Robin; Bu, Jingyu; Johnson, Paul M.; Rayson, Daniel; Grunfeld, Eva

doi:10.1245/s10434-011-2073-9

Cited by 21 publications

(14 citation statements)

References 30 publications

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“…Higher yield was not associated with an increased number of metastatic nodes in the current study, which is in agreement with recent large cohorts (33,34). Each factor likely influences the LN sample to a modest, yet significant, degree, as demonstrated by the multivariable modeling in this series.…”

Section: Resultssupporting

confidence: 91%

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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Section: Resultssupporting

confidence: 91%

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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“…In other words, the poor lymph node harvest did not cause significantly lower metastasis discovery. Despite an improved lymph node harvest over time, Porter et al 35 could identify neither an increase in node positivity nor a change in outcome in population-based study. Recently, Parsons et al 36 also found in their SEER database study an clearly improved lymph node harvest over time but no increase in lymph node positivity.…”

Section: Discussionmentioning

confidence: 93%

Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer

et al. 2013

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Lymph node staging is of paramount importance for prognosis estimation and therapy stratification in colorectal cancer. A high number of harvested lymph nodes is associated with an improved outcome. Methylene blue-assisted lymph node dissection effectively improves the lymph node harvest and ensures sufficient staging. Now, the effect on node positivity rate and stage-related outcome was investigated. The study cohort with advanced lymph node dissection consisted of 669 colorectal cancer cases of all stages, which were collected between 2007 and 2012. A historical collection of 663 cases investigated with conventional techniques between 2002 and 2004 served as control. Lymph node harvest was dramatically improved in the study group with mean lymph node numbers of 34±17 vs 13±5 (Po0.001) and sufficient staging rates of 98% vs 62% (Po0.001). However, neither the rate of nodal positive cases (37% vs 37%; P ¼ 0.98) nor the rate of N2 cases differed between the two groups (14% vs 13%; P ¼ 0.80). Furthermore, no differences were found concerning the outcome in both groups. The advanced lymph node dissection technique guarantees adequate histopathological lymph node staging in virtually all cases of colorectal cancer and is therefore extremely helpful. The hypothesis that it also provides a higher sensitivity in detecting metastases, however, could be not proved.

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“…Several studies have already reported an overall increase in LNY over the years without clinically relevant consequences, such as a rise in higher staged disease (i.e. N+) or improved outcomes [1,8,31,32]. Therefore, spending additional resources to find more small negative lymph nodes to reach this goal of 10 or 12 lymph nodes may in fact be some form of window dressing.…”

Section: Discussionmentioning

confidence: 99%

“…The number of lymph nodes needed for adequate staging of lymphatic spread of colorectal cancer continues to be a topic of debate [1]. Current guidelines advocate a minimum number of lymph nodes to be examined ranging from 10 in the Netherlands to 12 according to the American Joint Committee on Cancer Staging Manual [2].…”

Section: Introductionmentioning

confidence: 99%

Lymph Node Yield in Colon Cancer: Individuals Can Make the Difference

Costa¹,

Dekken

Witte

et al. 2015

Dig Surg

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Aim: To investigate the influence of individual surgeons and pathologists on examining an adequate (i.e. ≥10) number of lymph nodes in colon cancer resection specimens. Patients and Methods: The number of lymph nodes was evaluated in surgically treated patients for colon cancer at our hospital from 2008 through 2010, excluding patients who had received neo-adjuvant treatment. The patient group consisted of 156 patients with a median age of 73 (interquartile range (IQR) 63-82 years) and a median of 12 lymph nodes per patient (IQR 8-15). In 106 patients (67.9%), 10 or more nodes were histopathologically examined. Results: At univariate analysis, the examination of ≥10 nodes was influenced by tumour size (p = 0.05), tumour location (p = 0.015), type of resection (p = 0.034), individual surgeon (p = 0.023), and pathologist (p = 0.005). Neither individual surgeons nor pathologists did statistically and significantly influence the chance of finding an N+ status. Age (p = 0.044), type of resection (p = 0.007), individual surgeon (p = 0.012) and pathologist (p = 0.004) were independent prognostic factors in a multivariate model for finding ≥10 nodes. Conclusion: Though cancer staging was not affected in this study, individual efforts by surgeons and pathologists play a critical role in achieving optimal lymph node yield through conventional methods.

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Improving Nodal Harvest in Colorectal Cancer: So What?

Cited by 21 publications

References 30 publications

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

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

Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer

Lymph Node Yield in Colon Cancer: Individuals Can Make the Difference

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