Population-based study to re-evaluate optimal lymph node yield in colonic cancer

Paggio, Joseph C Del; Peng, Yingwei; Wei, Xuejiao; Nanji, Sulaiman; MacDonald, P.H.; Chandramohan, K; Booth, Christopher M.

doi:10.1002/bjs.10540

Cited by 20 publications

(15 citation statements)

References 47 publications

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“…The TNM system includes the metastatic involvement of regional lymph nodes. Traditionally 12 harvested lymph nodes have been recommended to enable staging and exclude metastatic disease, though a greater yield of cancer-free lymph nodes may increase the chance of survival 50 .…”

Section: Some Suggested Prognostic Markersmentioning

confidence: 99%

Colorectal Cancer Cells Adhere to Traumatized Peritoneal Tissue in Clusters, An Experimental Study

Falk

Jönsson

Swartling

et al. 2017

Journal of Investigative Surgery

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The use of human peritoneal tissue in an ex vivo model would appear to be a potentially useful tool for the study of interaction between human peritoneal membrane and free tumor cells. Experimental surgical trauma increases the ability of tumor cells to adhere to the peritoneal membrane. This ex vivo model should be useful in future studies on biological interactions between peritoneum and tumor cells in the search for novel forms of peritoneal cancer therapy.

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Section: Some Suggested Prognostic Markersmentioning

confidence: 99%

Colorectal Cancer Cells Adhere to Traumatized Peritoneal Tissue in Clusters, An Experimental Study

Falk

Jönsson

Swartling

et al. 2017

Journal of Investigative Surgery

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“…They were divided into three groups, < 12 (LN<12), 12 to 19 (LN12- 19) and ≥ 20 (LN≥20). Twenty was chosen as the cut off as a previous study showed no significant survival benefit beyond this number [7]. The difference between these groups was analysed with the χ 2 test for categorical variables and the one-way analysis of variance (ANOVA) test for continuous variables.…”

Section: Introductionmentioning

confidence: 99%

How does lymph node yield affect survival outcomes of stage I and II colon cancer?

Foo

Wei

et al. 2020

World J Surg Onc

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Background: According to the American Joint Committee on Cancer staging for cancer of the colon, a minimum of 12 lymph nodes (LN) has to be sampled for accurate staging. This has bearing on the long-term prognosis and the need for adjuvant chemotherapy. The aim of this study was to revisit the association of lymph node yield and the long-term survival in patients with stages I and II, i.e. node-negative, colon cancer. Method: Consecutive patients who underwent elective or emergency curative resections for cancer of colon between the years 2003 and 2012 were retrospectively reviewed. Only patients with stage I or II diseases (AJCC 8th edition) were included. They were analysed in three groups, LN<12, LN12-19 and LN≥20. Their clinic-pathological characteristics were compared. The disease-free (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Results: There was a total of 659 patients included in the analysis. Twelve or more LN were found in 65.6% of the specimens. The mean follow-up was 83.9 months. LN≥20 had significantly better DFS (p = 0.015) and OS (p = 0.036), whereas LN<12 had similar DFS and OS when compared to LN12-19. The advantage in DFS and OS were mainly seen in those with stage II diseases. A lymph node yield of greater than 20 was one of the predictors of favourable DFS, hazard ratio 0.358; 95% CI 0.170-.756, p = 0.007. Conclusion: The lymph node yield had a significant association with survival outcomes. A lymph node yield of 20 or more was associated with better survival outcomes. On the other hand, lymph node yield less than 12 was not shown to have inferior survival outcomes when compared to those between 12 and 19.

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“…With time, the quality of the pathological examinations, including reporting of the number of investigated nodes, has improved [27]. High numbers of investigated nodes correlate with better outcome in both stage II and III [28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?

Osterman

Hammarström

Imam

et al. 2020

Cancers

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Adjuvant chemotherapy aims at eradicating tumour cells sometimes present after radical surgery for a colorectal cancer (CRC) and thereby diminish the recurrence rate and prolong time to recurrence (TTR). Remaining tumour cells will lead to recurrent disease that is usually fatal. Adjuvant therapy is administered based upon the estimated recurrence risk, which in turn defines the need for this treatment. This systematic overview aims at describing whether the need has decreased since trials showing that adjuvant chemotherapy provides benefits in colon cancer were performed decades ago. Thanks to other improvements than the administration of adjuvant chemotherapy, such as better staging, improved surgery, the use of radiotherapy and more careful pathology, recurrence risks have decreased. Methodological difficulties including intertrial comparisons decades apart and the present selective use of adjuvant therapy prevent an accurate estimate of the magnitude of the decreased need. Furthermore, most trials do not report recurrence rates or TTR, only disease-free and overall survival (DFS/OS). Fewer colon cancer patients, particularly in stage II but also in stage III, today display a sufficient need for adjuvant treatment considering the burden of treatment, especially when oxaliplatin is added. In rectal cancer, neo-adjuvant treatment will be increasingly used, diminishing the need for adjuvant treatment.

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Population-based study to re-evaluate optimal lymph node yield in colonic cancer

Abstract: There is incongruity in the optimal LN evaluation for colonic cancer. Although the historically stated threshold of 12 LNs may ensure accurate staging in colonic cancer, thresholds for optimal survival are associated with far greater yields.

Cited by 20 publications

References 47 publications

Colorectal Cancer Cells Adhere to Traumatized Peritoneal Tissue in Clusters, An Experimental Study

Colorectal Cancer Cells Adhere to Traumatized Peritoneal Tissue in Clusters, An Experimental Study

How does lymph node yield affect survival outcomes of stage I and II colon cancer?

Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?

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