Number of Lymph Nodes Retrieved is an Important Determinant of Survival of Patients with Stage II and Stage III Colorectal Cancer

Abstract

Objective: The number of lymph nodes retrieved is recognized to be a prognostic factor of Stage II colorectal cancer. However, the prognostic significance of the number of lymph nodes retrieved in Stage III colorectal cancer remains controversial. Methods: The relationship between the number of lymph nodes retrieved and clinical and pathological factors, and significance of the number of lymph nodes retrieved for prognosis of Stage II and III colorectal cancer were investigated. A total of 16 865 patients with T3/T4 colorectal cancer who had R0 resection were analysed. Results: The arithmetic mean of the number of lymph nodes retrieved of all cases was 20.0. The number of lymph nodes retrieved were varied according to several clinical and pathological variables with significant difference, and the greater difference was observed in scope of nodal dissection. Survival of Stages II and III was significantly associated with the number of lymph nodes retrieved. Five-year overall survival of the patients with 9 of the number of lymph nodes retrieved and those with .27 differed by 6.4% for Stage II colon cancer, 8.8% for Stage III colon cancer, 12.5% for Stage II rectal cancer and 10.6% for Stage III rectal cancer. With one increase in the number of lymph nodes retrieved, the mortality risk was decreased by 2.1% for Stage II and by 0.8% for Stage III, respectively. The cut-off point of the number of lymph nodes retrieved was not obtained. Conclusions: The number of lymph nodes retrieved was shown to be an important prognostic variable not only in Stage II but also in Stage III colorectal cancer, and it was most prominently determined by the scope of nodal dissection. A cut-off value for the number of lymph nodes retrieved was not found, and it is necessary to carry out appropriate nodal dissection and examine as many lymph nodes as possible.

Clinico‐pathological factors influencing lymph node yield in colorectal cancer and impact on survival: Analysis of new zealand cancer registry data

“…In this study, LNY had an independent prognostic influence in Stage I-III CRC but not Stage IV CRC, as shown in Table IV and Figure 5. This confirms previous findings in Stage II-III colon cancer [15-17,37,] [44][45][46][47] but there is currently no explanation for this phenomenon. One possibility is that a stronger host anti-tumor immune response results in larger regional LNs that are detected more easily [48].…”

The survival and clinicopathological differences between patients with stage IIIA and stage II rectal cancer: An analysis of 12,036 patients in the SEER database

“…However, in colorectal cancer, apart from patients with distal metastasis (stage IV), all node-positive patients are categorized as stage III regardless of their T status based on the TNM classification [5]. Although lymph node status has been identified as an essential prognostic factor in colorectal cancer that can guide adjuvant therapy and evaluate prognosis [22, 23], the integration of TN categories into a cancer staging system remains complicated. Therefore, the over-estimated weighting of node metastasis in the current AJCC cancer staging system leads to poor monotonicity of gradients from the early to the advanced cancer stages in colorectal cancer [24, 25].…”

Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches

“…Lymph node (LN) status is the single most important predictor of survival in nonmetastatic colorectal cancer . Multiple studies have demonstrated a relationship between the number of LNs retrieved during colectomy and survival . Although the American Joint Committee on Cancer (AJCC) recommends a minimum of 12 nodes for adequate staging, an optimal cutoff has yet to be established .…”