Effect of Lymph Node Retrieval Rates on the Utilization of Adjuvant Chemotherapy in Stage II Colon Cancer
Failing to meet the benchmark of 12 lymph nodes in resection specimens is an indication for adjuvant chemotherapy in stage II colon cancer.Methods
Among consecutive eligible patients with pathologic stage II colon cancer treated at eight NCI-designated comprehensive cancer centers between September 1, 2005 and February 19, 2008, we analyzed receipt of adjuvant chemotherapy, with less than 12 versus 12+ lymph nodes removed and examined the primary explanatory variable of interest.ResultsAmong 258 patients, 46% received adjuvant chemotherapy. An oxaliplatin-containing regimen was used 67% of the time. Younger age (<50 years, P < 0.001), presence of lymphovascular invasion (P = 0.007), and higher T stage (P = 0.007) were independently associated with adjuvant chemotherapy use. There was significant inter-institutional variability in practice with the proportion receiving treatment ranging from 17% to 64% (P < 0.05). Notably, presence of less than 12 lymph nodes in the surgical specimen was a strong predictor of treatment (P = 0.008).Conclusions
Adjuvant chemotherapy use after resection of stage II colon cancer is common, but by no means standard practice at National Comprehensive Cancer Network (NCCN) institutions. More attention to achieving the recommended benchmark for lymph node dissection has the potential to decrease exposure to the toxicity of adjuvant treatment. J. Surg. Oncol. 2009;100:525–528. © 2009 Wiley-Liss, Inc.
Available from: Torsten Liersch
- "Neoadjuvant RCT has repeatedly been accused of reducing lymph node yield in rectal cancer specimens [28-31]. It has also been reported that the number of detected nodes in stage II rectal cancer patients influences survival [32-34]. Within our investigation, we evaluated a median number of 21 lymph nodes per specimen. "
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ABSTRACT: Response to preoperative radiochemotherapy (RCT) in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR) is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT.
From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3), treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0) total mesorectal excision (TME) in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS) and overall survival (OS).
Residual tumor transgression into the mesorectal compartment (ypT3) did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively). Nodal involvement after preoperative RCT (ypN1/2) turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively). Persistent tumor infiltration of the mesorectum (ypT3) and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p < 0.001).
Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0) resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters.
Available from: lexjansen.com
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ABSTRACT: The National Comprehensive Cancer Network (NCCN) Colorectal Cancer (CRC) Outcomes Database collects outcomes data on patients presenting with primary colon or rectal cancer at eight NCCN institutions across the United States. The primary objective of the database is to evaluate patient demographics and clinical characteristics, types of treatments received, and number of patients concordant with NCCN treatment guidelines and quality measures, which in turn are reported back to participating institutions and physicians. These treatment guidelines are updated on a continual basis and developed by multidisciplinary panels from NCCN institutions. This article focuses on a SAS to Excel application, developed to automate the reporting of the concordance with treatment guidelines and quality measures. The report includes histograms of treatments received for colorectal cancer, and the number and proportion of patients that received concordant care, along with the 95% confidence intervals and institution range for each treatment guideline and quality measure. The sample SAS code and the final Excel report are presented using aggregate data from the NCCN CRC Outcomes Database.
Available from: Jong Duk Lee
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