The Evaluation of More Lymph Nodes in Colon Cancer Is Associated with Improved Survival in Patients of All Ages

Abstract

BackgroundImprovement in survival of patients with colon cancer is reduced in elderly patients compared to younger patients. The aim of this study was to investigate whether the removal of ≥ 12 lymph nodes can explain differences in survival rates between elderly and younger patients diagnosed with colon cancer.MethodsIn a population-based cohort study, all patients (N = 41,074) diagnosed with colon cancer stage I to III from 2003 through 2010 from the Netherlands Cancer Registry were included. Age groups were defined as < 66, 66–75 and > 75 years of age. Main outcome measures were overall and relative survival, the latter as a proxy for disease specific survival.ResultsOver an eight years time period there was a 41.2% increase in patients with ≥ 12 lymph nodes removed, whereas the percentage of patients with the presence of lymph node metastases remained stable (35.7% to 37.5%). After adjustment for patient and tumour characteristics and adjuvant chemotherapy, it was found that for patients in which ≥ 12 lymph nodes were removed compared to patients with < 12 lymph nodes removed, there was a statistically significant higher overall survival (< 66: HR: 0.858 (95% CI, 0.789–0.933); 66–75: HR: 0.763 (95% CI, 0.714–0.814); > 75: HR: 0.734 (95% CI, 0.700–0.771)) and relative survival (< 66: RER: 0.783 (95% CI, 0.708–0.865); 66–75: RER: 0.672 (95% CI, 0.611–0.739); > 75: RER: 0.621 (95% CI, 0.567–0.681)) in all three age groups.ConclusionsThe removal of ≥ 12 lymph nodes is associated with an improvement in both overall and relative survival in all patients. This association was stronger in the elderly patient. The biology of this association needs further clarification.

Patterns of age disparities in colon and lung cancer survival: a systematic narrative literature review

“…For example, fifteen studies did not report the time origin from which the survival time had been calculated 16,20,26,28–32,35–37,41,43,51,52 , and six studies did not indicate the end of follow-up date 29,35,36,41,44,52 . In 28 articles the authors did not report follow-up time 16–21,26–31,35,37–44,46,48,52–54 , and the number of deaths were missing in 26 artides 16,18–21,27–32,35,37–41,43,44,48,49,52–54 only three studies reported the source of age at diagnosis (from medical records) 27,30–44 . In seven studies, the authors did not provide numerical survival estimates 16–19,21,26,46 .…”

“…Only one study analysed a random sample of patients 26 . Of seventeen studies examining colon cancer, five studies aimed at investigating age disparities in colon cancer survival (Table 2) 16,17,31,32,34 . Six studies used data from The Netherlands 16,17,21,27,30,32 , and five presented data from the U.S.A. 26,31,33,34–54 .…”

Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the National Cancer Data Base

“…Hoehn et al 14 found that patients were less likely to have their lymph nodes examined if they were treated at CCCs, which may explain the lower OS. Studies in colon cancer have confirmed that the evaluation of more lymph nodes is associated with improved survival due to more accurate staging 15 …”

microRNA-630 promotes cell proliferation and inhibits apoptosis in the HCT116 human colorectal cancer cell line

“…Colorectal cancer is the third most common cancer worldwide with a high rate of morbidity and mortality (1). Each year, there are over one million newly diagnosed cases and approximately 600,000 cases of colorectal cancer-associated mortality (2). The major risk factors of colorectal cancer are increasing age and lifestyle factors, and other risk factors include obesity, insulin resistance and metabolic syndrome (3).…”

“…The major risk factors of colorectal cancer are increasing age and lifestyle factors, and other risk factors include obesity, insulin resistance and metabolic syndrome (3). The survival of this disease has improved considerably, however, the 5-year relative survival for patients aged 65 years and older remains as low as 60% (2). An improved understanding of the underlying mechanisms of colorectal cancer may provide valuable information for treating this disease.…”