Pooled Analysis of Fluorouracil-Based Adjuvant Therapy for Stage II and III Colon Cancer: Who Benefits and by How Much?

Gill, Sharlene; Loprinzi, Charles L.; Sargent, Daniel J.; Thomé, Stephan D.; Alberts, Steven R.; Haller, Daniel G.; Benedetti, Jacqueline; Francini, Guido; Shepherd, Lois E.; Seitz, Jean François; Labianca, Roberto; Chen, Wei; Stephen, S.; Heldebrant, Michael P.; Goldberg, Richard M.

doi:10.1200/jco.2004.09.059

Cited by 915 publications

(631 citation statements)

References 46 publications

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“…Eine retrospektive Untersuchung an 1306 Patienten mit einem Stadium-IITumor zeigte in einer multivariaten Analyse, dass die Kategorie T4 mit einem schlechten krankheitsfreien Überleben assoziiert war (HR 1,75) [893]. In der Studie von Moertel (n = 318) besitzt die T4-Kategorie im Stadium II keine zusätzliche prognostische Bedeutung [887], wohl aber in der Studie von Burdy (n = 108) [894], in der Erlanger Analyse (n = 305) [891] und in der veröffent-lichten Metaanalyse von Gill [875]. Nach einer Notfalloperation resultierte mit 29,8 vs 52,4 % eine signifikant niedrigere 5-Jahres-Überlebensrate (p < 0,001).…”

Section: Level Of Evidence 1aunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

136

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Section: Level Of Evidence 1aunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

136

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“…In contrast, the benefit in stage II cancers is minimal, and the decision of whether to use an adjuvant therapy depends on additional risk factors. 2 Insufficient lymph node harvest is one of these factors. 3 However, the number of lymph nodes needed for sufficient lymph node staging is still a matter of debate.…”

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confidence: 99%

The clinical significance of lymph node size in colon cancer

et al. 2012

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To date, the clinical value of lymph node size in colon cancer has been investigated only in a few studies. Only in radiological diagnosis is lymph node size routinely recognized, and nodes Z10 mm in diameter are considered pathologic. However, the few studies regarding this topic suggest that lymph node size is not a reliable indicator of metastatic disease. Moreover, we hypothesized that increasing lymph node size is associated with favorable outcome. By performing a morphometric study, we investigated the clinical significance of lymph node size in colon cancer in terms of metastatic disease and prognosis. A cohort of 237 cases with excellent lymph node harvest (mean lymph node count: 33±17) was used. The size distribution in node-positive and -negative cases was almost identical. In all, 151 out of the 305 metastases detected (49.5%) were found in lymph nodes with diameters r5 mm. Only 25% of lymph nodes 410 mm showed metastases. Minute lymph nodes r1 mm were involved only very rarely (2 of 81 cases). In 67% of the cases, the largest positive lymph node was o10 mm. The prognostic relevance of lymph node size was investigated in a subset of 115 stage I/II cases. The occurrence of Z7 lymph nodes that were 45 mm in diameter was significantly associated with better overall survival. Our data show that lymph node size is not a suitable factor for preoperative lymph node staging. Minute lymph nodes have virtually no role in correct histopathological lymph node staging. Finally, large lymph nodes in stage I/II disease might indicate a favorable outcome.

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“…1 In contrast to stage III cancers, the benefit of adjuvant chemotherapy is limited in stage II cases and, therefore, is offered only in defined risk situations. 2,3 Insufficient lymph node harvest is one of these risk factors. A harvest of at least 12 nodes is required by the Union for International Cancer Control for adequate staging.…”

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confidence: 99%

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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Pooled Analysis of Fluorouracil-Based Adjuvant Therapy for Stage II and III Colon Cancer: Who Benefits and by How Much?

Cited by 915 publications

References 46 publications

S3-Leitlinie – Kolorektales Karzinom

S3-Leitlinie – Kolorektales Karzinom

The clinical significance of lymph node size in colon cancer

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

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