Clinicopathological Factors Affecting Lymph Node Yield and Positivity in Left-Sided Colon and Rectal Cancers

Appaiah, Nikhil Nanjappa Ballanamada; Iqbal, Muhammad Rafaih; Lesi, Omotara Kafayat; Maruvanda, Sushmitha Medappa; Cai, Wenli; Rajakumar, Andrien; Khan, Laeeq

doi:10.7759/cureus.19115

Cited by 4 publications

(6 citation statements)

References 28 publications

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“…In the systematic review, six articles showed that tumour location was not significantly associated with the LN yield in colorectal cancer25 26 35 40 64 65; however, four articles revealed association, without explaining the specific association 5 34 36 63. Ten articles revealed that more LNs could be obtained from the right colon than the other locations 21 22 25 29 31 37 39 41 44 48.…”

Section: Resultsmentioning

confidence: 98%

“…From these articles, 90 articles were excluded because the papers were not in English or Chinese (n=2), had unavailable data (n=23) and were unrelated (n=65). Finally, 54 studies were included, with 30 included in the systematic review,5 19–47 and 24 in the meta-analysis (figure 1). 12–14 48–68…”

Section: Resultsmentioning

confidence: 99%

“…In the systematic review, 20 articles revealed no significant association between age and the retrieval of LNs in colorectal cancer 21–23 26 27 30 32 35 37–41 47–49 54 55 64 65. However, 18 articles indicated that more LNs were obtained from young patients than elderly patients (online supplemental table 6).…”

Section: Resultsmentioning

confidence: 99%

“…In the systematic review of association between the T stage and LN yield in colorectal cancer, 12 studies mentioned that the T stage had no significant association with the LN yield,23 26 29 30 32 35 39 40 42 44 47 54 but eight articles revealed that more LNs were obtained from the advanced T stage than early T stage 21 25 27 28 37 41 51 62. Moreover, four articles mentioned that the T stage was associated with the harvested LNs,19 24 36 48 without explaining the specific association.…”

Section: Resultsmentioning

confidence: 99%

“…21 36 39 41 47 In the meta-analysis of 8 studies with 3813 patients, the LN yield was not significantly different between the positive and negative groups (OR=1.13, 95% CI (0.84 to 1.53), p=0.419, I 2 =36.98%) (figure 2 and online supplemental figure 22). 51 53 58 63 65-68 Publication bias and sensitivity analysis Sensitivity analysis was performed for all articles (online supplemental figure 10 and online supplemental figures [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Most studies revealed stable results, indicating the reliability of the findings.…”

Section: Factors Associated With the Number Of Retrievable Lns Demogr...mentioning

confidence: 99%

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Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Liu,

Huang,

Yang

et al. 2023

BMJ Open

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ObjectiveClinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.DesignSystematic review and meta-analysis of primary studies.Data sourcesPubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.Eligibility criteria for selecting studiesStudies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.Data extraction and synthesisOR with 95% conference intervals was extracted and pooled.ResultsA total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph–vascular invasion were not significantly associated with the lymph node yield.ConclusionsThe study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Factors Associated With the Number Of Retrievable Lns Demogr...mentioning

confidence: 99%

See 3 more Smart Citations

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Liu,

Huang,

Yang

et al. 2023

BMJ Open

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Determinants of Lymph Node Yield and Involvement in Resectable Colon Cancer: A Study of Anatomical, Pathological, and Fresh, Nonfixed Specimen Dissection

Behera

Chandramohan²,

Muralee³

et al. 2023

Indian J Surg

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Optimal examined lymph node number for accurate staging and long-term survival in rectal cancer: a population-based study

Guan,

Jiao,

Wen

et al. 2023

International Journal of Surgery

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Background: Although the recommended minimal examined lymph node (ELN) number in rectal cancer (RC) is 12, this standard remains controversial because of insufficient evidence. We aimed to refine this definition by quantifying the relationship between ELN number, stage migration, and long-term survival in RC. Methods: Data from a Chinese multi-institutional registry and the Surveillance, Epidemiology, and End Results (SEER) database on stage I to III resected RC (2008 - 2017) were analysed to determine the relationship between ELN count, stage migration, and overall survival (OS) using multivariable models. The series of odds ratios (ORs) for negative-to-positive node stage migration and hazard ratios (HRs) for survival with more ELNs were fitted using a LOWESS smoother, and structural breakpoints were determined using the Chow test. The relationship between ELN and survival was evaluated on a continuous scale using restricted cubic splines (RCS). Results: The distribution of ELN count between the Chinese registry (n = 7,694) and SEER database (n = 21,332) was similar. With increasing ELN count, both cohorts exhibited significant proportional increases from node-negative to node-positive disease (SEER, OR, 1.012, P < 0.001; Chinese registry, OR, 1.016, P = 0.014) and serial improvements in OS (SEER, HR, 0.982; Chinese registry, HR, 0.975; both P < 0.001) after controlling for confounders. Cut-point analysis showed an optimal threshold ELN count of 15, which was validated in the two cohorts, with the ability to properly discriminate probabilities of survival. Conclusions: A higher ELN count is associated with more precise nodal staging and better survival. Our results robustly conclude that 15 ELNs are the optimal cut-off point for evaluating the quality of lymph node examination and stratification of prognosis.

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Clinicopathological Factors Affecting Lymph Node Yield and Positivity in Left-Sided Colon and Rectal Cancers

Cited by 4 publications

References 28 publications

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Determinants of Lymph Node Yield and Involvement in Resectable Colon Cancer: A Study of Anatomical, Pathological, and Fresh, Nonfixed Specimen Dissection

Optimal examined lymph node number for accurate staging and long-term survival in rectal cancer: a population-based study

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