Predictive Value of the Number of Harvested Lymph Nodes and Cut-Off for Lymph Node Ratio in the Prognosis of Stage II and III Colorectal Cancer Patients

G, Li Destri; Barchitta, Martina; Pesce, Antonio; Latteri, Saverio; Bosco, D; Cataldo, Antonio Di; Agodi, Antonella; Puleo, Stefano

doi:10.1080/08941939.2017.1369605

Cited by 28 publications

(23 citation statements)

References 30 publications

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“…Destri [18] found that stage II patients with ELN <12 tend to have shorter DFS than stage II patients with ELN ≥12, and in stage III patients, ELN >12 is a better prognostic factor. These studies formed the guideline threshold of the AJCC recommendation of at least 12 LNs for all CRC patients [3].…”

Section: Discussionmentioning

confidence: 99%

“…Patient Population. Population-based data on CRC patients from the US Surveillance, Epidemiology, and End Results (SEER)- 18 Program from 1988-2014 (https://seer .cancer.gov/) was extracted and evaluated, as ELN count was available since 1988. The inclusion criteria were patients with colorectal adenocarcinoma, who underwent surgical resection, a T3 or T4 tumor, tumor parameters available in the SEER-18 database, ELN numbers available, no distant metastasis, tumor-specific related death information was available.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study

Lei

Ruan

Liu

et al. 2020

Gastroenterology Research and Practice

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Background. Evaluation of lymph node status is critical in colorectal carcinoma (CRC) treatment. However, as patients with node involvement may be incorrectly classified into earlier stages if the examined lymph node (ELN) number is too small and escape adjuvant therapy, especially for stage II CRC. The aims of this study were to assess the impact of the ELN on the survival of patients with stage II colorectal cancer and to determine the optimal number. Methods. Data from the US Surveillance, Epidemiology, and End Results (SEER) database on stage II resected CRC (1988-2013) were extracted for mathematical modeling as ELN was available since 1988. Relationship between ELN count and stage migration and disease-specific survival was analyzed by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS (Locally Weighted Scatterplot Smoothing) smoother, and the structural break points were determined by the Chow test. An independent cohort of cases from 2014 was retrieved for validation in 5-year disease-specific survival (DSS). Results. An increased ELN count was associated with a higher possibility of metastasis LN detection (OR 1.010, CI 1.009-1.011, p<0.001) and better DSS in LN negative patients (OR 0.976, CI 0.975-0.977, p<0.001). The cut-off point analysis showed a threshold ELN count of 21 nodes (HR 0.692, CI 0.667-0.719, p<0.001) and was validated with significantly better DSS in the SEER 2009 cohort CRC (OR 0.657, CI 0.522-0.827, p<0.001). The cut-off value of the ELN count in site-specific surgeries was analyzed as 20 nodes in the right hemicolectomy (HR 0.674, CI 0.638-0.713, p<0.001), 19 nodes in left hemicolectomy (HR 0.691, CI 0.639-0.749, p<0.001), and 20 nodes in rectal resection patients (HR 0.671, CI 0.604-0.746, p<0.001), respectively. Conclusions. A higher number of ELNs are associated with more-accurate node staging and better prognosis in stage II CRCs. We recommend that at least 21 lymph nodes be examined for accurate diagnosis of stage II colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study

Lei

Ruan

Liu

et al. 2020

Gastroenterology Research and Practice

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“…Among 1407 patients treated with NACRT and staged ypN0 (stage II), the number of lymph nodes retrieved, even when < 12, was not associated with survival and did not, therefore, have prognostic value. By contrast, among patients with metastatic lymph nodes (stage III), the LNR had a prognostic role regardless of the lymph node yield [11,31]. In our opinion, if the LNR were incorporated into the AJCC staging system [13] when the lymph node yield is < 12, the incidence of stage migration would be reduced [17].…”

Section: Discussionmentioning

confidence: 71%

The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

Maugeri

Ramistella

et al. 2020

Updates Surg

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According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.

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“…Multiple studies have demonstrated an inverse relationship between the lymph node ratio (LNR; the number of positive lymph nodes divided by the total number of nodes evaluated) and disease‐free or overall survival . Berger et al showed that patients with N1 disease and a high LNR (>40%) had worse 5‐year survival than patients with N2 disease and a low LNR (<20%), demonstrating the importance of a larger denominator of lymph nodes evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Berger et al showed that patients with N1 disease and a high LNR (>40%) had worse 5‐year survival than patients with N2 disease and a low LNR (<20%), demonstrating the importance of a larger denominator of lymph nodes evaluated. The prognostic power of this ratio loses its significance with less than 10 to 12 nodes evaluated, further illustrating the importance of maximizing the number of nodes assessed …”

Section: Discussionmentioning

confidence: 99%

Carnoy's solution fixation with compression significantly increases the number of lymph nodes yielded from colorectal cancer specimens

Flynn

Burchette

Ghassemi

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Carnoy's fixation and compression represents a novel technique to enhance lymph node evaluation and accuracy of staging after colorectal cancer resection. Methods This study was performed in all adults undergoing colorectal cancer operations by Kaiser Permanente surgeons at two separate facilities. Patients were assigned to either location based upon surgeon and patient availability. One group of patients had their lymph nodes examined with current standard manual technique (MT). The other group had their specimens fixed with Carnoy's solution and then compressed (CT) to assess for lymph nodes. Results A total of 157 patients were enrolled. Seventy‐eight patient specimens underwent MT and 79 patient specimens underwent the new compression technique (CT). CT resulted in a significant increase in total lymph node yield per specimen (37.6 ± 18.5 nodes with CT vs 18.9 ± 8.8 nodes with MT; P < 0.0001). CT also resulted in sufficient lymph node sampling (>12 nodes) in all 79 patients in the group compared with 13 of 78 patients (17%) with an insufficient lymph node evaluation in the MT group ( P = 0.0002). Conclusion This study demonstrated that Carnoy's fixation with compression can significantly increase lymph node yields in colorectal cancer specimens and allow for a higher rate of adequate lymph node sampling.

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Predictive Value of the Number of Harvested Lymph Nodes and Cut-Off for Lymph Node Ratio in the Prognosis of Stage II and III Colorectal Cancer Patients

Abstract: Stage II patients with LNS < 12 tend to have shorter DFS than stage II patients with LNS ≥ 12. In stage III patients, an appropriate LNR cut-off is a better prognostic predictor than LNR quartile, especially in patients with LNS ≥ 12.

Cited by 28 publications

References 30 publications

Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study

Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study

The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

Carnoy's solution fixation with compression significantly increases the number of lymph nodes yielded from colorectal cancer specimens

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