Does Reevaluation of Colorectal Cancers With Inadequate Nodal Yield Lead to Stage Migration or the Identification of Metastatic Lymph Nodes?

Lahey Clinic, Burlington, MA, Cleveland Clinic, Cleveland, OH
Diseases of the Colon & Rectum (Impact Factor: 3.75). 04/2014; 57(4):432-437. DOI: 10.1097/DCR.0000000000000052
Source: PubMed


The National Comprehensive Cancer Network recommends routine reevaluation of all stage II colon cancer specimens with fewer than 12 lymph nodes. However, there are few data demonstrating the effect of reevaluation on stage.
The aim of this study was to demonstrate the effect of pathologic reevaluation for colorectal cancers with fewer than 12 lymph nodes on stage.
This study entailed a retrospective review of pathology reports.
This study was conducted at 2 large multispecialty referral centers.
Pathologic reevaluation was performed to look for additional lymph nodes.
All patients with stage I through III colorectal cancers with inadequate lymph node yields who underwent reevaluation from January 1, 2007 through March 31, 2011 were identified.
We recorded initial pathologic stage and new stage following reevaluation. The following variables before and after reevaluation were also recorded: 1) total lymph node count, 2) metastatic node count, 3) negative node count, and 4) lymph node ratio.
Eighty-three patients underwent pathologic reevaluation from a total of 1682 cancer specimens. Mean nodal yields were 7.2 ± 2.6 on the first pathologic review. On reevaluation, 80% of patients had one or more newly identified nodes. On average, 6.9 ± 9.6 more lymph nodes were identified with a metastatic node detected in 4 of 83 patients (4.8%). After pathologic reevaluation, 1 patient (1.2%) had a change in TNM stage from N1 to N2 disease. The lymph node ratio changed in 13 of 15 patients (87% of stage III cancers). Only 4 of these had a change in lymph node quartile.
The study was limited by its retrospective nature and small sample size.
Few patients have a newly discovered metastatic node or stage change following pathologic reevaluation. The effect of pathologic reevaluation on treatment and outcome should be further investigated.

Download full-text


Available from: Dilara Seyidova Khoshknabi, Nov 18, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colon and rectal adenocarcinomas differ at a multitude of levels. The association between outcome and predictor in 1 group may obscure the relationship between outcome and predictor in the other. The current study aims to evaluate the prognostic properties of lymphovascular invasion in colon and rectal adenocarcinoma separately. A comparative retrospective analysis was undertaken to determine the prognostic properties of lymphovascular invasion in colon and rectal adenocarcinomas. Patients were classified as lymphovascular invasion positive and lymphovascular invasion negative in separate colon and rectal cancer cohorts. Within cohorts, a univariate analysis was undertaken to determine the association between lymphovascular invasion positivity and local/systemic recurrence and overall/disease-free survival. Findings were evaluated by using Kaplan-Meier estimates, log-rank analysis, and a Cox proportional hazards multivariate model. The primary outcomes measured were overall and disease-free survival. Five hundred twenty-seven patients were included in the analysis (379 with colon cancer and 148 with rectal cancer). On univariate analysis, lymphovascular invasion positivity was associated with adverse locoregional recurrence in colon (p = 0.002) but not rectal adenocarcinoma (p = 0.13). Conversely, lymphovascular invasion positivity was associated with adverse systemic recurrence in rectal (p = 0.002) but not colon adenocarcinoma (p = 0.35). On multivariate analysis, lymphovascular invasion positivity was an independent predictor of adverse disease-free survival in colon (p = 0.02) and rectal adenocarcinoma (p < 0.001). Regarding overall survival, lymphovascular invasion positivity was a poor prognostic indicator in rectal adenocarcinoma only (p = 0.04). In this retrospective analysis, lymphovascular invasion positivity was associated with different patterns of disease recurrence in colon and rectal cancer. Lymphovascular invasion positivity was associated with adverse overall survival in rectal cancer only.
    No preview · Article · Jun 2015 · Diseases of the Colon & Rectum
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the influence of individual surgeons and pathologists on examining an adequate (i.e. ≥10) number of lymph nodes in colon cancer resection specimens. The number of lymph nodes was evaluated in surgically treated patients for colon cancer at our hospital from 2008 through 2010, excluding patients who had received neo-adjuvant treatment. The patient group consisted of 156 patients with a median age of 73 (interquartile range (IQR) 63-82 years) and a median of 12 lymph nodes per patient (IQR 8-15). In 106 patients (67.9%), 10 or more nodes were histopathologically examined. At univariate analysis, the examination of ≥10 nodes was influenced by tumour size (p = 0.05), tumour location (p = 0.015), type of resection (p = 0.034), individual surgeon (p = 0.023), and pathologist (p = 0.005). Neither individual surgeons nor pathologists did statistically and significantly influence the chance of finding an N+ status. Age (p = 0.044), type of resection (p = 0.007), individual surgeon (p = 0.012) and pathologist (p = 0.004) were independent prognostic factors in a multivariate model for finding ≥10 nodes. Though cancer staging was not affected in this study, individual efforts by surgeons and pathologists play a critical role in achieving optimal lymph node yield through conventional methods. © 2015 S. Karger AG, Basel.
    Full-text · Article · Jun 2015 · Digestive surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stage migration is an accepted explanation for the association between lymph node (LN) yield and outcome in colon cancer. To investigate whether the alternative thesis of immune response is more likely, we performed a retrospective study. We enrolled 239 cases of node negative cancers, which were categorized according to the number of LNs with diameters larger than 5 mm (LN5) into the groups LN5-very low (0 to 1 LN5), LN5-low (2 to 5 LN5), and LN5-high (≥6 LN5). Significant differences were found in pT3/4 cancers with median survival times of 40, 57, and 71 months (P = .022) in the LN5-very low, LN5-low, and LN5-high groups, respectively. Multivariable analysis revealed that LN5 number and infiltration type were independent prognostic factors. LN size is prognostic in node negative colon cancer. The correct explanation for outcome differences associated with LN harvest is probably the activation status of LNs. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · American journal of surgery