Evaluating the impact of lymph node resampling on colorectal cancer nodal stage

Abstract

Evaluating the impact of lymph node resampling on colorectal cancer nodal stage Aims: Nodal staging in colorectal cancer (CRC) informs prognosis and guides adjuvant treatment decisions. A standard minimum of 12 lymph nodes is widely used, with additional sampling being performed as required. However, there are few data on how lymph node resampling in this context has an impact on nodal stage. The aims of this study were to evaluate the effectiveness of resampling in detecting metastases and tumour deposits, and the impact on stage. Methods and results: A retrospective cohort analysis was performed on CRC resections that underwent resampling because of an initial yield of <12 lymph nodes, from 2008 to 2018. Data relating to patient demographics, specimen, malignancy and prosection were collected. Slides were reviewed to quantify nodal metastases and tumour deposits before and after resampling. Among ≥pN1 cases, logistic regression analysis was performed to evaluate factors that predicted the finding of additional metastases and tumour deposits. The cohort comprised 395 cases: resampling identified nodal metastases and/or tumour deposits in 30 (7.6%) cases; nodal upstaging occurred in 20 (5.1%) cases; and eight (2.0%) cases changed from pN0 to ≥pN1. No factors predicted resampling of positive lymph nodes or tumour deposits, and pN upstaging occurred across a variety of cases. A subgroup analysis was performed to assess the impact of resampling on high-risk features in stage II cases (n = 117). There were 33 (8.5%) patients who no longer had any high-risk features after resampling. Conclusions: Lymph node resampling has an impact on nodal staging and possible treatment decisions in a considerable proportion of patients, and is recommended in all cases with <12 lymph nodes.

Identifying Recurrences Among Non-Metastatic Colorectal Cancer Patients Using National Health Data Registries: Validation and Optimization of a Registry-Based Algorithm in a Modern Danish Cohort

“…10 However, the predictive performance of the algorithm may have changed since 2011 because of improvements in care and, consequently, changes in recurrence risk. Changes in care include, eg, the implementation of central vascular ligation, complete mesocolic excision, increased lymph node yield, 11 implementation of population-based CRC screening, 12 and standardization of diagnostic CT-imaging. 13 In addition, the algorithm has not previously been validated with regard to time to recurrence (TTR).…”

Impact of Lymph Node Retrieval on Prognosis in Elderly and Non-Elderly Patients with T3-4 Stage Rectal Cancer Following Neoadjuvant Therapy

“…The number of lymph nodes detected from resected colorectal cancer specimens is a key factor in pathologic staging and has been shown to correlate with survival, especially in rectal cancer, where a su cient number of lymph nodes cleared has become an important indicator of the quality of radical surgery for rectal cancer [12] . Both the National Comprehensive Cancer Network (NCCN) and the American Joint Committee on Cancer (AJCC) recommend the detection of at least 12 lymph nodes after surgery for colorectal cancer tumors [13] . However, this conclusion comes from rectal cancer patients who did not receive neoadjuvant therapy and underwent radical surgical resection as initial treatment.…”

Predicting treatment failure in stage III colon cancer patients after radical surgery

“…Marital status was regrouped as married or unmarried (single, widowed, divorced and separated). The number of lymph nodes (nLN) sampled was regrouped as <12 or ≥12, and tumor size was regrouped as < 5 cm or ≥5 cm according to the X-tile program ( 8 ). A total of 360 patients with stage III colon cancer was collected from Longyan First Affiliated hospital of Fujian Medical University to validate model externally.…”