More Extensive Nodal Dissection Improves Survival for Stages I to III of Colon Cancer

Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, CA 90404, USA.
Annals of Surgery (Impact Factor: 8.33). 11/2006; 244(4):602-10. DOI: 10.1097/01.sla.0000237655.11717.50
Source: PubMed


To determine whether analyzing more lymph nodes in colon cancer specimens improves survival.
Increasing the number of lymph nodes analyzed has been reported to correlate with improved survival in patients with node-negative colon cancer.
The Surveillance, Epidemiology, and End Results database was queried for all patients undergoing resection for histologically confirmed colon cancer between the years 1988 and 2000. Patients were excluded for distant metastases or if an unknown number of nodes was sampled. The number of nodes sampled was categorized into 0, 1 to 7, 8 to 14, and > or =15 nodes. Survival curves constructed using the Kaplan-Meier method were compared using log rank testing. A Cox proportional hazard model was created to adjust for year of diagnosis, age, race, gender, tumor grade, tumor size, TNM stage, and percent of nodes positive for tumor.
The median number of lymph nodes sampled for all 82,896 patients was 9. For all stages examined, increasing nodal sampling was associated with improved survival. Multivariate regression demonstrated that patients who had at least 15 nodes sampled as compared with 1 to 7 nodes experienced a 20.6% reduction in mortality independent of other patient and tumor characteristics.
Adequate lymphadenectomy, as measured by analysis of at least 15 lymph nodes, correlates with improved survival, independent of stage, patient demographics, and tumor characteristics. Currently, most procedures do not meet this guideline. Future trials of adjuvant therapy should include extent of lymphadenectomy as a stratification factor.

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Available from: Steven Chen, Sep 15, 2014
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    • "It is recommended that a minimum of 12 lymph nodes be examined before the patient is considered free of lymph node metastases [4]. Actually, other reports recommended that more lymph nodes should be examined to ensure proper staging [5,6]. However, it is time-consuming and impractical to obtain more lymph nodes. "
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    ABSTRACT: Purpose Clinical usefulness of sentinel lymph node (SLN) mapping in colorectal cancer remains controversial. The aim of this study is to evaluate the accuracy of the SLN mapping technique using serial sectioning, and to compare the results between ex vivo and in vivo techniques. Methods From February 2011 to October 2012, 34 colon cancer patients underwent SLN mapping during surgical resection. Eleven patients were analyzed with the in vivo method, and 23 patients with the ex vivo method. Patient characteristics and results of SLN mapping were evaluated. Results The SLN mapping was performed in 34 patients. Mean age was 67.3 years (range, 44-81 years). Primary tumors were located in the following sites: 13 in the right colon (38.2%) and 21 in the left colon (61.8%). SLN mapping was performed successfully in 88.2% of the patients. There was no significant difference in the identification rate between the two methods (90.9% vs. 87.0%, P = 1.000). Both the mapping methods showed a low sensitivity and high rate of skip metastasis. Conclusion This study showed that SLN evaluation using serial sectioning could not predict the nodal status with clinically acceptable accuracy despite the high detection rate.
    Annals of Surgical Treatment and Research 09/2014; 87(3):118-22. DOI:10.4174/astr.2014.87.3.118
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    • "Several studies have documented the association between patient attribute, tumor characteristics, process (treatment), pathological finding and the survival of colorectal cancer. Prognostic or risk factors frequently observed for survival are gender [8,9], age [9], comorbidity [10], number of lymph nodes examined [11-13], tumor size [14], tumor TNM staging [12,15], depth of tumor invasion [16], safety surgical margin [17], chemotherapy [18-21] and radiotherapy [22]. Except radiotherapy, the prognostic significance of these variables was confirmed in our study by Cox proportional hazard model. "
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    ABSTRACT: To define different prognostic groups of surgical colorectal adenocarcinoma patients derived from recursive partitioning analysis (RPA). Ten thousand four hundred ninety four patients with colorectal adenocarcinoma underwent colorectal resection from Taiwan Cancer Database during 2003 to 2005 were included in this study. Exclusion criteria included those patients with stage IV disease or without number information of lymph nodes. For the definition of risk groups, the method of classification and regression tree was performed. Main primary outcome was 5-year cancer-specific survival. We identified six prognostic factors for cancer-specific survival, resulting in seven terminal nodes. Four risk groups were defined as following: Group 1 (mild risk, 1,698 patients), Group 2 (moderate risk, 3,129 patients), Group 3 (high risk, 4,605 patients) and Group 4 (very high risk, 1,062 patients). The 5-year cancer-specific survival for Group 1, 2, 3, and 4 was 86.6%, 62.7%, 55.9%, and 36.6%, respectively (p < 0.001). Hazard ratio of death was 2.13, 5.52 and 10.56 (95% confidence interval 1.74-2.60, 4.58-6.66 and 8.66-12.9, respectively) times for Group 2, 3, and 4 as compared to Group 1. The predictive capability of these grouping was also similar in terms of overall and progression-free survival. The use of RPA offered an alternative grouping method that could predict the survival of patients who underwent surgery for colorectal adenocarcinoma.
    BMC Medical Research Methodology 01/2012; 12(1):2. DOI:10.1186/1471-2288-12-2 · 2.27 Impact Factor
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    • "In one study, a mean harvest of more than 28 lymph nodes was reported [2]. Data from the SEER database demonstrated that a cutoff value of 15 was useful, and perhaps, there is an inherent limit to the number of nodes necessary to achieve this effect on survival [20]. Nevertheless, the hypothesis that a larger (negative) lymph node yield is beneficial is contradicted even from highly rated institutions [21]. "
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    ABSTRACT: A national surveillance program of colon cancer treatment was introduced in 2007. We examined prognostic factors for colon cancer operated in 2000 with an aim of improving survival in the new program and a special focus on the merit of lymph node yield. A cohort of 269 patients, 152 women (56.5%), with a mean age of 71 years, was operated for colon cancer in 2000 at three teaching hospitals and followed up for 7 years. Overall 5-year survival was 58.0%, and overall hospital mortality was 5.2%, with 4.5% in elective cases and 12.5% after urgent surgery. In only 41.1% of the specimens were 12 or more lymph nodes retrieved, but this did not affect survival in the combined cohort, although one of the hospitals achieved a significantly better result with a harvest of 12 or more lymph nodes. In a multivariate analysis, old age, gender, a high lymph node ratio (LNR) at stage III, and tumor-node-metastasis stage were adverse factors for survival. The operative mortality was high and should be reassessed. The lymph node count did not have a significant impact on outcome overall, whereas the LNR proved significant for stage III. A prospective protocol using overall lymph node yield as a surrogate measure for more radical surgery, nevertheless, seems warranted to improve the lymph node harvest according to international recommendations.
    International Journal of Colorectal Disease 05/2011; 26(10):1299-307. DOI:10.1007/s00384-011-1244-2 · 2.45 Impact Factor
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