Lymph node evaluation and survival after resection of colorectal cancer

Recent studies have demonstrated that lymph nodes ratio (LNR) might provide a significant prognostic role for colorectal cancer. We retrospectively analyzed the data of the patients with colorectal cancer and assessed a possible correlation between lymph node parameters and survival. We conducted a retrospective chart review of patients who underwent a radical colon surgery involving removal of mesocolic lymph nodes due to colorectal cancer. Prognostic significance of the removed lymph node number (LNs), metastatic LNs, lymph node ratio (LNR) and other factors were compared. This retrospective study included 190 patients (117 males and 73 females). The estimated survival period was found to be 87.70 months [confidence interval (CI) of 95% (80.64-94.76)]. LNR, LNs and N stage were found to have significant correlation with survival. Among these factors, LNR had the biggest correlation (r = 0 .138, P =0.028). Multivariate regression analysis of survival with lymph node parameters showed that LNR and N stage were significantly correlated with survival. However, LNR was found to be the most significant prognostic factor [P >0.0001, 95% CI; 3.12 (1.55-5.75)]. LNR is a better prognostic factor in patients with colorectal cancer compared to lymph node stage and number

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1. Bikhchandani J, Ong GK, Dozois EJ, Mathis KL. Outcomes of salvage surgery for cure in patients with locally recurrent disease after local excision of rectal cancer. Dis Colon Rectum. 2015;58(3):283-7.

2. Radespiel-Tröger M, Hohenberger W, Reingruber B. Improved prediction of recurrence after curative resection of colon carcinoma using tree-based risk stratification. Cancer. 2004;100(5):958-67.

3. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-4.

4. Shia J, Wang H, Nash GM, Klimstra DS. Lymph node staging in colorectal cancer: revisiting the benchmark of at least 12 lymph nodes in R0 resection. J Am Coll Surg. 2012;214(3):348-55.

5. Tsai HL, Lu CY, Hsieh JS, Wu DC, Jan CM, Chai CY, Chu KS, Chan HM, Wang JY. The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer. J Gastrointest Surg. 2007;11(5):660-5.

6. Vather R, Sammour T, Zargar-Shoshtari K, Metcalf P, Connolly A, Hill A. Lymph node examination as a predictor of long term outcome in Dukes B colon cancer. Int J Colorectal Dis. 2009;24(3):283-8.

7. Sigurdson ER. Lymph node dissection: Is it diagnostic or therapeutic? J Clin Oncol. 2003;21(6):965-7.

8. Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst. 2005;97(3):219-25.

9. Wang J, Hassett JM, Dayton MT, Kulaylat MN. Lymph node ratio: role in the staging of node-positive colon cancer. Ann Surg Oncol. 2008;15(6):1600-8.

10. Ghahramani L, Moaddabshoar L, Razzaghi S, Hamedi SH, Pourahmad S, Mohammadianpanah M. Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer. Ann Colorectal Res. 2013;1(3):81-91.

11. Storli KE, Søndenaa K, Bukholm IR, Nesvik I, Bru T, Furnes B, Hjelmeland B, Iversen KB, Eide GE. Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age. Int J Colorectal Dis. 2011;26(10):1299-307.

12. Sugimoto K, Kawai M, Takehara K, Tashiro Y, Munakata S, Nagayasu K, Niwa K, Ishiyama S, Komiyama H, Takahashi M, Kojima Y, Goto M, Tomiki Y, Sakamoto K. The validity of predicting prognosis by the number of lymph node metastases in node-positive colon cancer. Open Journal of Gastroenterology. 2013; 3(4):217-22.

13. Sadaka E, Maria A, El-Shebiney M. Lymph node ratio as a prognostic factor in stage III colon cancer. Journal of American Science. 2012;8(9):1137-41.

14. Park YH, Lee JI, Park JK, Jo HJ, Kang WK, An CH. Clinical Significance of Lymph Node Ratio in Stage III Colorectal Cancer. J Korean Soc Coloproctol. 2011;27(5):260-5.

15. Ren JQ, Liu JW, Chen ZT, Liu SJ, Huang SJ, Huang Y, Hong JS.Prognostic value of the lymph node ratio in stage III colorectal cancer. Chin J Cancer. 2012;31(5):241-7.

16. Chang GJ, Feig BW. Cancer of the Colon, Rectum, and Anus. In: Feig BW, Berger DH, Fuhrman GM,editors. The M.D. Anderson Surgical Oncology Handbook 4th Ed. Houston, Texas; Lippincott Williams&Wilkins; 2006. p. 261-320

17. Swanson RS, Compton CC, Stewart AK, Bland KI. The Prognosis of T3N0 Colon Cancer is Dependent on the Number of Lymph Nodes Examined. Ann Surg Oncol. 2003;10(1):65-71.

18. Sobin LH, Gaspodarowicz M, Wittekind C. TNM classification of malignant tumors. 7thed. New York: Wiley-Blackwell, ; 2009.Colon and rectum p.100-5

19. Nachiappan S, Askari A, Mamidanna R, Munasinghe A, Currie A, Stebbing J, Faiz O. The impact of adjuvant chemotherapy timing on overall survival following colorectal cancer resection. Eur J Surg Oncol. 2015;41(12):1636-44.

20. Turner J, Vollmer RT. Lymph nodes in colorectal carcinoma. The Poisson probability paradigm. Am J Clin Pathol. 2006;125(6):866-72.

21. Li Destri G, Di Carlo I, Scilletta R, Scilletta B, Puleo S. Colorectal cancer and lymph nodes: the obsession with the number 12. World J Gastroenterol. 2014;20(8):1951-60.

22. Denham LJ, Kerstetter JC, Herrmann PC. The complexity of the count: considerations regarding lymph node evaluation in colorectal carcinoma. J Gastrointest Oncol. 2012;3(4):342-52.

23. Evans MD, Barton K, Rees A, Stamatakis JD, Karandikar SS. The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes' stage B disease. Colorectal Dis. 2008;10(2):157-64.

24. Ko CY, Chang JT, Chaudhry S, Kominski G. Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery. 2002;132(2):268-73.

25. Panageas KS, Schrag D, Riedel E, Bach PB, Begg CB. The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med. 2003;139(8):658-65.

26. Billingsley KG, Morris AM, Dominitz JA, Matthews B, Dobie S, Barlow W, Wright GE, Baldwin LM. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007;142(1):23-31; discussion 32.

27. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation technical notes and outcome. Colorectal Dis. 2009;11(4):354-64; discussion 364-5.

28. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon.J Clin Oncol. 2010;28(2):272-8.

29. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D; National Cancer Institute Expert Panel. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93(8):583-96.

30. Yu H, Luo Y, Wang X, Kang L, Huang M, Deng Y, Wang L, Wang J.The effect of patterns of recurrence after radical resection of rectal cancer on long-term survival after recurrence. Zhonghua Yi Xue Za Zhi. 2016;96(8):625-8.

31. Sarli L, Bader G, Iusco D, Salvemini C, Mauro DD, Mazzeo A, Regina G, Roncoroni L. Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer. 2005;41(2):272-9.

32. Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003;21(15):2912-9.

33. Tsikitis VL, Larson DL, Wolff BG, Kennedy G, Diehl N, Qin R, Dozois EJ, Cima RR. Survival in stage III colon cancer is independent of the total number of lymph nodes retrieved. J Am Coll Surg. 2009;208(1):42-7.

34. Wang J, Kulaylat M, Rockette H, Hassett J, Rajput A, Dunn KB, Dayton M. Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg. 2009;249(4):559-63.

35. Moore J, Hyman N, Callas P, Littenberg B. Staging error does not explain the relationship between the number of lymph nodes in a colon cancer specimen and survival. Surgery. 2010;147(3):358-65.

36. Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O, Birkmeyer JD. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA. 2007;298(18):2149-54.

37. Bui L, Rempel E, Reeson D, Simunovic M. Lymph node counts, rates of positive lymph nodes, and patient survival for colon cancer surgery in Ontario, Canada: a population-based study. J Surg Oncol. 2006;93(6):439-45.

38. Jestin P, Pahlman L, Glimelius B, Gunnarsson U. Cancer staging and survival in colon cancer is dependent on the quality of the pathologists specimen examination. Eur J Cancer. 2005;41(14):2071- 8.

39. Lemmens VE, Verheij CD, Janssen-Heijnen ML, Rutten HJ, Coebergh JW; Gastro-Intestinal Cancer Study Group Comprehensive Cancer Centre South IKZ, Eindhoven, The Netherlands. Mixed adherence to clinical practice guidelines for colorectal cancer in the Southern Netherlands in 2002. Eur J Surg Oncol. 2006;32(2):168-73.

40. Maurel J, Launoy G, Grosclaude P, Rutten HJ, Coebergh JW; GastroIntestinal Cancer Study Group Comprehensive Cancer Centre South IKZ, Eindhoven, The Netherlands. Lymph node harvest reporting in patients with carcinoma of the large bowel: a French populationbased study. Cancer. 1998;82(8):1482-6.

41. Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon: Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985;312(25):1604-8.

42. Rosenberg R, Friederichs J, Schuster T, Gertler R, Maak M, Becker K, Grebner A, Ulm K, Höfler H, Nekarda H, Siewert JR. Prognosis of patients with colorectal cancer is assciated with lymph Node ratio: a single center analysis analysis of 3026 patients over a 25-year time period. Ann Surg. 2008;248(6):968-78.

43. Noura S, Ohue M, Kano S, Shingai T, Yamada T, Miyashiro I, Ohigashi H, Yano M, Ishikawa O. Impact of lymph node ratio in node positive colorectal cancer. World J Gasrointest Surg. 2010;2(3):70-7.

44. Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23(34):8706-12.

45. Lee HY, Choi HJ, Park KJ, Shin JS, Kwon HC, Roh MS, Kim C. Prognostic significance of metastatic lymph node ratio in nodepositive colon carcinoma. Ann Surg Oncol. 2007;14(5):1712-7.

46. Vaccaro CA, Im V, Rossi GL, Quintana GO, Benati ML, Perez de Arenaza D, Bonadeo FA. Lymph node ratio as prognostic factor for colon cancer treated by colorectal surgeons. Dis Colon Rectum. 2009;52(7):1244-50.

47. Thomas M, Biswas S, Mohamed F, Chandrakumaran K, Jha M, Wilson R. Dukes C colorectal cancer: is the metastatic lymph node ratio important? Int J Colorectal Dis. 2012;27(3):309-17.

48. Kwon TS, Choi SB, Lee YS, Kim JG, Oh ST, Lee IK. Novel Methods of Lymph Node Evaluation for Predicting the Prognosis of Colorectal Cancer Patients with Inadequate Lymph Node Harvest. Cancer Res Treat. 2016;48(1):216-24.

49. Ceelen W, Van Nieuwenhove Y, Pattyn P. Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol. 2010;17(11):2847-55.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
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