Number of Nodes Examined and Staging Accuracy in Colorectal Carcinoma

Wong, Jan H.; Severino, Ricardo; Honnebier, M. B. O. M.; Tom, Paul; Namiki, Thomas

doi:10.1200/jco.1999.17.9.2896

Cited by 314 publications

(232 citation statements)

References 14 publications

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“…It has been shown that the total number of lymph nodes recovered and examined has an impact on the accurate staging of colorectal carcinoma. 9,10 The explanation for this finding is that failure to resect and analyze a sufficient number of lymph nodes may result in inadvertently missing small but clinically important metastatic deposits. These same studies indicate that at least 14 lymph nodes per specimen must be examined for staging to be accurate.…”

Section: Discussionmentioning

confidence: 99%

A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping

Patten

Berger

Rodrı́guez-Bigas

et al. 2004

Cancer

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BACKGROUNDAlthough the utility of lymphatic mapping (LM) and sentinel lymph node (SLN) biopsy in patients with melanoma and breast carcinoma has been well documented, this same is not true for patients with colon carcinoma. The authors previously reported a high false‐negative rate for SLN biopsy in patients with colon carcinoma using isosulfan blue dye alone. The objective of the current study was to determine whether radiocolloid would increase the sensitivity of LM/SLN biopsy in patients with colon carcinoma.METHODSThe authors performed LM on 57 patients with colon carcinoma using both isosulfan blue dye and radiocolloid. The SLN(s) were identified by either their blue color or by increased radioactivity. The SLNs then underwent both routine histologic sectioning and immunohistochemical (IHC) staining for cytokeratins.RESULTSAn SLN was identified in 56 patients (98%). Radiocolloid was able to identify only 1 additional positive SLN (9%). Overall, it was found that the disease had metastasized to the lymph nodes in 22 patients, even though there was no evidence of disease in the SLN(s) in 11 of those 22 patients on routine histologic sectioning (false‐negative rate, 50%; sensitivity, 50%). In five patients, IHC of the SLN was the only indicator of metastatic disease. The inclusion of IHC‐positive SLNs in these calculations would decrease the false‐negative rate to 17% and would increase the sensitivity of SLN biopsy to 83%.CONCLUSIONSIn the current study, the addition of radiocolloid did not increase the sensitivity of detection of positive SLN(s) compared with the use of isosulfan blue dye alone. IHC of the SLN potentially may increase the sensitivity of LM and reduce the false‐negative rate. However, the long‐term prognostic significance of IHC in patients with colon carcinoma remains controversial. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping

Patten

Berger

Rodrı́guez-Bigas

et al. 2004

Cancer

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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]. Still, in the absence of a unique molecular signature of a colon tumor that dictates therapies and predicts a patient's course, the American College of Surgeons, ASCO, NCCN and others have adopted this as an indicator for quality assessment [24,26].…”

Section: Journal Of Surgical Oncologymentioning

confidence: 99%

“…There has been great discussion and variability in the literature about the number of nodes that need to be examined to stage patients with accuracy [5,[7][8][9][10][11][12][13]. In addition, a substantial body of literature suggests that the absolute number of lymph nodes removed, whether positive or negative, is independently correlated with survival [14,15].…”

Section: Introductionmentioning

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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“…A higher number of LN retrieved in the surgical specimen increases the probability of metastatic LN; therefore, patients with stage III rectal cancer might have a higher average number of LN examined than do stage I-II patients [28,39]. In our study, we observed that the median number of LN harvested was lower in stage I-II patients than in stage III patients (p = 0.079).…”

Section: Discussionmentioning

confidence: 47%

“…. Nevertheless, the number of metastatic LN is related not only to the depth of tumor wall invasion, but also on the number of LN examined [26][27][28], which, in turn, varies depending on several other factors, including patient-related variables (age, gender, body mass index), tumorrelated variables (size, stage, and grade), the surgeon, and the pathologist [29].…”

Section: Discussionmentioning

confidence: 99%

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

et al. 2012

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BackgroundThe lymph node ratio (LNR; number of positive nodes divided by total nodes harvested) has been demonstrated to be a prognostic factor in colon cancer, but its role in extraperitoneal rectal cancer is still debated; furthermore, no data are available on laparoscopic rectal resection. The aim of this study was to evaluate the prognostic impact of LNR on long-term outcomes after laparoscopic total mesorectal excision (LTME) for extraperitoneal cancer in consecutive patients with a 5-year minimum follow-up. Methods This study is a prospective analysis of consecutive patients who underwent LTME for adenocarcinoma of the extraperitoneal rectum. Results LTME was performed in 158 patients. The median number of LN harvested was 12 (range = 3-25). The proportion of specimens with fewer than 12 examined LN was significantly higher in patients who had neoadjuvant chemoradiotherapy (p < 0.001). During a median follow-up period of 122 months, the local recurrence rate was 8 %. At univariate analysis, disease-free survival and overall survival significantly decreased with increasing LNR (p < 0.001). Multivariate analysis showed that the distal margin ≤1 cm was the only independent predictor of local recurrence (p = 0.028). LNR (cutoff value = 0.25) and lymphovascular invasion were significant prognostic factors for both disease-free (p = 0.015 and p = 0.046, respectively) and overall survival (p = 0.031 and p = 0.040, respectively). Even in the subgroup of patients in whom fewer than 12 LN were examined, LNR confirmed its prognostic role, with a statistical trend toward worse disease-free survival and overall survival. Conclusion Metastatic LNR is an independent prognostic factor for disease-free survival and overall survival after LTME for extraperitoneal rectal cancer. Keywords Lymph node ratio Survival Laparoscopy Total mesorectal excision Rectal cancer Excellence of surgical technique is of particular relevance in the treatment of extraperitoneal rectal cancer. Routine excision of the intact mesorectum during resection of cancer of the middle and lower rectum has resulted in a significant decrease in local recurrence rates [1]. Developed and popularized by Heald and co worker [1], total mesorectal excision (TME) is presently the surgical gold standard, with a 4 % local recurrence rate and a 78 % tumor-free survival rate in curative cases at 5 years [2]. A recent meta-analysis by Huang et al. [3] of randomized controlled trials that included small numbers of patients with upper or mid-to-low rectal cancer did not show differences between laparoscopic and open surgery in terms of the number of lymph nodes (LN) harvested, local recurrence, 3-year disease-free survival, and overall survival. Although a minimum of 12 LN in the

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Number of Nodes Examined and Staging Accuracy in Colorectal Carcinoma

Abstract: In a sample of patients statistically similar to the sample in the NCDB report, the examination of at least 14 nodes after resection of T2 or T3 carcinoma of the colon and rectum will accurately stage the lymphatic basin.

Cited by 314 publications

References 14 publications

A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping

A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping

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

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

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