Lymph Node Evaluation in Colorectal Cancer Patients: A Population-Based Study

Baxter, Nancy N.; Virnig, Dan J.; Rothenberger, David A.; Morris, Arden M.; Jessurun, José; Virnig, Beth A

doi:10.1093/jnci/dji020

Cited by 454 publications

(431 citation statements)

References 32 publications

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“…[20][21][22] In addition, for colorectal cancer, it has been demonstrated that the number of assessed lymph nodes increases as surgical and hospital volumes increase. [22][23][24][25][26] The exact contribution of each of these factors to the improvement in survival with increasing TLN or whether TLN is a surrogate of overall quality as it pertains to postoperative care, follow-up, or subsequent therapy could not be determined in the current study.…”

Section: Lymph Nodes In Small Bowel Carcinoma/overman Et Almentioning

confidence: 99%

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Overman

Wolff

et al. 2010

Cancer

100

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BACKGROUND:The presence of distant metastases and the completeness of resection are important prognostic factors in patients with small bowel adenocarcinoma (SBA); however, the influence of lymph node metastasis on patient outcome has not been well characterized. The objective of the current study was to evaluate the impact of the number of positive and negative lymph nodes on survival after curative resection. METHODS: Patients who had SBA diagnosed between 1988 and 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox proportional hazards regression analyses were performed after adjusting for age, sex, race, tumor stage, tumor grade, and primary site. Five-year disease-specific survival (DSS) was determined, all patients were categorized according to the total lymph nodes (TLNs) assessed, and patients with stage III disease also were categorized according to the number of positive lymph nodes (PLNs) and the PLN-to-TLN ratio (the lymph node ratio [LNR]). RESULTS: In total, 1991 patients (n ¼ 1216 with stage I/II SBA and n ¼ 775 with stage III SBA) were analyzed. Survival depended on the TLNs assessed. The 5-year DSS rate for patients with stage II disease was associated with the TLNs assessed (44%, 69%, and 83% for 0 TLNs, 1-7 TLNs, and >7 TLNs, respectively). The 5-year DSS for patients with stage III disease was associated with the number of PLNs (58% and 37% for <3 PLNs and 3 PLNs, respectively). Among patients with stage III disease, the LNR was even more predictive of survival than stratification by the number of PLNs. CONCLUSIONS: Survival after surgical resection for stage I, II, and III SBA was associated with the TLNs assessed. Stratifying patients with stage III disease into those with <3 PLNs and 3 PLNs significantly improved prognostication. Cancer 2010;116:5374-82.

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Section: Lymph Nodes In Small Bowel Carcinoma/overman Et Almentioning

confidence: 99%

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Overman

Wolff

et al. 2010

Cancer

100

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“…There is a controversy, however, in the literature about whether the number of lymph nodes resected and evaluated impacts patient outcomes [29,30]. Further ambiguity exists even among the proponents of this quality metric regarding the exact number of lymph nodes needed to accurately stage a patient with colon cancer [5,[7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Journal Of Surgical Oncologymentioning

confidence: 99%

Meeting the 12 lymph node (LN) benchmark in colon cancer

Rajput

Romanus

Weiser

et al. 2010

Journal of Surgical Oncology

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Background: Examining 12 LN in colon cancer has been suggested as a quality metric. The purpose of this study was to determine whether the 12 LN benchmark is achieved at NCCN centers compared to a US population-based sample. Methods: Patients with stage I-III disease resected at NCCN centers were identified from a prospective database (n ¼ 718) and were compared to 12,845 stage I-III patients diagnosed in a SEER region. Age, gender, location, stage, number of positive nodes were compared for NCCN and SEER data in regards to number of nodes evaluated. Multivariate logistic regression models were developed to identify factors associated with evaluating 12 LNs. Results: 92% of NCCN and 58% of SEER patients had 12 LN evaluated. For patients treated at NCCN centers, factors associated with not meeting the 12 LN target were left-sided tumors, stage I disease and BMI >30. Conclusions: 12 LN are almost always evaluated in NCCN patients. In contrast, this target is achieved in 58% of SEER patients. With longer follow-up of the NCCN cohort we will be able to link this quality metric to patterns of recurrence and survival and thereby better understand whether increasing the number of nodes evaluated is a priority for cancer control.

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“…The number of metastatic lymph nodes identified may be influenced by the total number of lymph nodes examined, thus increasing the probability of stage migration [6][7][8][9]. The number of lymph nodes examined at the time of colectomy varies widely and may result from variations in surgical technique, the thoroughness of the pathologist, the actual number of regional lymph nodes, or individual differences in the behavior of the tumor, such as the immune response, which may affect the lymph node size and morphology [10,11].…”

Section: Introductionmentioning

confidence: 99%

Nodal stage of stage III colon cancer: The impact of metastatic lymph node ratio

Park

Choi

Jun

2009

Journal of Surgical Oncology

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Purpose:We assessed which classification of lymph node metastasis better predicted outcomes in patients with colorectal carcinoma. Methods: We identified 318 patients (176 men) with stage III colon cancer who underwent curative resection. The number of LNs dissected, LNR, and disease-free survival time, were analyzed. Lymph node disease was stratified by the American Joint Committee on Cancer staging and LNR, with the latter categorized into groups with LNR <0.059 (n ¼ 67), 0.059-0.23 (n ¼ 171), and >0.23 (n ¼ 80). Median follow-up time was 37 (range, 1-122) months. Results: LNR significantly increased with the number of metastatic LNs (P < 0.0001). Three-year disease-free survival (DFS) rates differed significantly in the three LNR groups. Within each TNM stage, 3-year DFS rates differed according to LNR, but, within each LNR subgroup, 3-year DFS did not differ according to TNM stage. When both TNM stage and LNR subgroup were considered, 3-year DFS was stratified into four groups, which differed significantly (P < 0.0001). Considering number of retrieved lymph nodes, this stratification was not found when <12 lymph nodes retrieved. Conclusions: Re-stratified lymph node staging, reflecting both LNR and TNM stage, can predict survival in patients with LN-positive colon cancer, especially when more than 12 lymph nodes harvested.

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Lymph Node Evaluation in Colorectal Cancer Patients: A Population-Based Study

Cited by 454 publications

References 32 publications

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Meeting the 12 lymph node (LN) benchmark in colon cancer

Nodal stage of stage III colon cancer: The impact of metastatic lymph node ratio

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