Lymph Node Evaluation and Long-Term Survival in Stage II and Stage III Colon Cancer: A National Study

Vather, Ryash; Sammour, Tarik; Kahokehr, Arman; Connolly, Andrew B.; Hill, Andrew G.

doi:10.1245/s10434-008-0265-8

Cited by 144 publications

(128 citation statements)

References 27 publications

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“…This might be explained by differences in the NLNE in the population. The mean NLNE per patient was reported to range from 11 to 14 for Stages II and III CRCs in Western countries such as the USA (3,16), UK (20) and New Zealand (15), whereas the corresponding figure was as high as 20, and the proportion of institutions with NLNE 12 reached 86% in the population analyzed in this study.…”

mentioning

confidence: 59%

“…We cannot gauge the significance of variations in the NLNE on the incidence of stage migration simply by analyzing the prognostic association of the NLNE at the patient level because the NLNE of individual patients is multifactorial (4 -7). Although a number of reports have shown that a lower NLNE is associated with an unfavorable prognostic outcome in colorectal cancer (CRC) patients (8 -16), a lower NLNE could be associated with not only insufficient LN sampling but also the quality of surgery (6,7,13,15), as well as patient factors, including poor host response against the tumor (5,17). In addition, differences between institutions in their actual routine practice of processing surgical specimens, both in LN retrieval and post-LN retrieval stages, could be a cause of stage migration, but this issue has not been focused on.…”

Section: Introductionmentioning

confidence: 99%

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Potential Causes of Stage Migration and Their Prognostic Implications in Colon Cancer: A Nationwide Survey of Specialist Institutions in Japan

Ueno

Hase

Hashiguchi

et al. 2014

Japanese Journal of Clinical Oncology

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Objective: The actual status of stage migration in colon cancer that occurs in the procedure of preparing pathological specimens of lymph nodes has not been fully investigated. Methods: A nationwide survey of specialist institutions for colon cancer treatment was conducted to clarify interinstitutional differences in processing surgical specimens. After categorizing 111 institutions on the basis of their practice of processing specimens, distribution of tumor stage and the recurrence status of 3294 colon cancer patients treated with the same level of lymphadenectomy were compared. Results: Patients were diagnosed with lower tumor stages in non-teaching hospitals, in hospitals where lymph nodes were retrieved by less experienced clinicians and in hospitals in which lymph nodes were retrieved with procedures that preserved the planes of surgery around the primary tumor. However, the process of sectioning and embedding lymph nodes did not affect stage distribution. The average number of lymph nodes examined per case in each institute was 19.4. Institutional number of lymph nodes examined was not associated with node positivity but it did affect the substage in Stage III for number of lymph nodes examined 21. In contrast, none of the factors associated with stage migration caused interinstitutional differences in the recurrence status according to the tumor stage. Conclusions: Considerable variety in the processing of surgical specimens existed even within one country, which could be a cause of stage migration in colon cancer. Better awareness of the clinical impact of the lymph node retrieval process is needed; an international guideline to standardize the treatment of surgical specimens might increase the value of tumor staging.

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confidence: 59%

Section: Introductionmentioning

confidence: 99%

Potential Causes of Stage Migration and Their Prognostic Implications in Colon Cancer: A Nationwide Survey of Specialist Institutions in Japan

Ueno

Hase

Hashiguchi

et al. 2014

Japanese Journal of Clinical Oncology

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“…Vather et al [57] reported the significance of LN evaluation in 4309 stage Ⅱ and stage Ⅲ colon cancer patients. In stage Ⅱ and stage Ⅲ colon cancer patients, the mean numbers of LNs examined were 13.7 and 13.8, respectively.…”

Section: Lnr In Crcmentioning

confidence: 99%

Impact of metastatic lymph node ratio in node-positive colorectal cancer

Noura

Ohue²,

Kano³

et al. 2010

WJGS

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Colorectal cancer (CRC) is one of the most common malignant diseases in the world. Presently, the most widely used staging system for CRC is the tumor nodes metastasis classification system, which classifies patients into prognostic groups according to the depth of the primary tumor, presence of regional lymph node (LN) metastases, and evidence of distant metastatic spread. The number of LNs with confirmed metastasis is related to the severity of the disease, but this number depends on the number of LNs retrieved, which varies depending on patient age, tumor grade, surgical extent, and tumor site. Numerous studies and a recent structured review have demonstrated associated improvements in the survival of CRC patients with increasing numbers of LNs retrieved for examination. Hence, the impact of lymph node ratio (LNR), defined as the number of metastatic LNs divided by the number of LNs retrieved, has been investigated in various malignancies, including CRC. In this editorial, we review the literature demonstrating the clinicopathological significance of LNR in CRC pati ents. Some reports have indicated the advantage of considering the LNR compared to the number of LNs retrieved and/or LN status. When the LNR is taken into consideration for survival analysis, the number of LNs retrieved and/or the LN status is not always found to be a prognostic factor. The cutoff points for LNRs were proposed in numerous studies. However, optimal thresholds for LNRs have not yet received consensus. It is still unclear whether the LNR has more prognostic validity than N stage. For all these reasons, the potential advantages of LNRs in the staging system should be investigated in large prospective data sets.

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“…24 Moreover, one could hypothesize that lymphatic hyperplasia in colon cancer could be a prognostic marker indicating an especially effective immunological response against the cancer. [25][26][27][28] As large lymph nodes are easier to find, this could be an alternative explanation for the phenomenon that high lymph node counts are associated with a favorable outcome in stage II and even in stage III colon cancer. 29 Until now, insufficient surgical techniques and, even more likely, stage migration are thought to explain this well-investigated effect.…”

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confidence: 99%

The clinical significance of lymph node size in colon cancer

et al. 2012

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To date, the clinical value of lymph node size in colon cancer has been investigated only in a few studies. Only in radiological diagnosis is lymph node size routinely recognized, and nodes Z10 mm in diameter are considered pathologic. However, the few studies regarding this topic suggest that lymph node size is not a reliable indicator of metastatic disease. Moreover, we hypothesized that increasing lymph node size is associated with favorable outcome. By performing a morphometric study, we investigated the clinical significance of lymph node size in colon cancer in terms of metastatic disease and prognosis. A cohort of 237 cases with excellent lymph node harvest (mean lymph node count: 33±17) was used. The size distribution in node-positive and -negative cases was almost identical. In all, 151 out of the 305 metastases detected (49.5%) were found in lymph nodes with diameters r5 mm. Only 25% of lymph nodes 410 mm showed metastases. Minute lymph nodes r1 mm were involved only very rarely (2 of 81 cases). In 67% of the cases, the largest positive lymph node was o10 mm. The prognostic relevance of lymph node size was investigated in a subset of 115 stage I/II cases. The occurrence of Z7 lymph nodes that were 45 mm in diameter was significantly associated with better overall survival. Our data show that lymph node size is not a suitable factor for preoperative lymph node staging. Minute lymph nodes have virtually no role in correct histopathological lymph node staging. Finally, large lymph nodes in stage I/II disease might indicate a favorable outcome.

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Lymph Node Evaluation and Long-Term Survival in Stage II and Stage III Colon Cancer: A National Study

Cited by 144 publications

References 27 publications

Potential Causes of Stage Migration and Their Prognostic Implications in Colon Cancer: A Nationwide Survey of Specialist Institutions in Japan

Potential Causes of Stage Migration and Their Prognostic Implications in Colon Cancer: A Nationwide Survey of Specialist Institutions in Japan

Impact of metastatic lymph node ratio in node-positive colorectal cancer

The clinical significance of lymph node size in colon cancer

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