Nelleke P M Brouwer1, Rutger C H Stijns2, Valery E P P Lemmens3, Iris D Nagtegaal4, Regina G H Beets-Tan5, Jurgen J Fütterer2, Pieter J Tanis6, Rob H A Verhoeven7, Johannes H W de Wilt8. 1. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: nelleke.brouwer@radboudumc.nl. 2. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 3. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands. 4. Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. 6. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 7. Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands. 8. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
BACKGROUND: This study aims to provide insight in the quality of current daily practice in clinical lymph node staging in colorectal cancer (CRC) in the Netherlands. METHODS: Data of the nationwide population-based Netherlands Cancer Registry between 2003 and 2014 were used to analyze lymph node staging for cM0 CRC patients. Accuracy of clinical lymph node staging was calculated for the period 2011-2014. Analyses were performed for patients without preoperative treatment or treated with short-course radiotherapy (SCRT) followed by resection. RESULTS: 100,211 patients were included for analysis. The proportion clinically positive lymph nodes increased significantly between 2003 and 2014 (6%-22% for colon cancer; 7%-53% for rectal cancer). The proportion histological positive lymph nodes remained stable (±35% colon, ±33% rectum). Data from 2011 to 2014 yielded a sensitivity, specificity, positive and negative predictive value of 41%, 84%, 59% and 71% for colon cancer, respectively (n = 21,629). This was 38%, 87%, 56%, 76% for rectal cancer without SCRT, (n = 2178) and 56%, 67%, 47% and 75% for rectal cancer with SCRT (n = 3401), respectively. CONCLUSION: Accuracy of clinical lymph node staging in colorectal cancer patients is about as accurate as flipping a coin. This may lead to overtreatment of rectal cancer patients. Acceptable specificity and NPV limit the risk of undertreatment.
BACKGROUND: This study aims to provide insight in the quality of current daily practice in clinical lymph node staging in colorectal cancer (CRC) in the Netherlands. METHODS: Data of the nationwide population-based Netherlands Cancer Registry between 2003 and 2014 were used to analyze lymph node staging for cM0 CRCpatients. Accuracy of clinical lymph node staging was calculated for the period 2011-2014. Analyses were performed for patients without preoperative treatment or treated with short-course radiotherapy (SCRT) followed by resection. RESULTS: 100,211 patients were included for analysis. The proportion clinically positive lymph nodes increased significantly between 2003 and 2014 (6%-22% for colon cancer; 7%-53% for rectal cancer). The proportion histological positive lymph nodes remained stable (±35% colon, ±33% rectum). Data from 2011 to 2014 yielded a sensitivity, specificity, positive and negative predictive value of 41%, 84%, 59% and 71% for colon cancer, respectively (n = 21,629). This was 38%, 87%, 56%, 76% for rectal cancer without SCRT, (n = 2178) and 56%, 67%, 47% and 75% for rectal cancer with SCRT (n = 3401), respectively. CONCLUSION: Accuracy of clinical lymph node staging in colorectal cancerpatients is about as accurate as flipping a coin. This may lead to overtreatment of rectal cancerpatients. Acceptable specificity and NPV limit the risk of undertreatment.
Authors: Nelleke P M Brouwer; Dave E W van der Kruijssen; Niek Hugen; Ignace H J T de Hingh; Iris D Nagtegaal; Rob H A Verhoeven; Miriam Koopman; Johannes H W de Wilt Journal: Ann Surg Oncol Date: 2019-12-02 Impact factor: 5.344
Authors: Seth I Felder; Sebastian Feuerlein; Arthur Parsee; Iman Imanirad; Julian Sanchez; Sophie Dessureault; Richard Kim; Sarah Hoffe; Jessica Frakes; James Costello Journal: Abdom Radiol (NY) Date: 2020-10-28
Authors: Jan Marie de Gooyer; Fortuné M K Elekonawo; Andreas J A Bremers; Otto C Boerman; Erik H J G Aarntzen; Philip R de Reuver; Iris D Nagtegaal; Mark Rijpkema; Johannes H W de Wilt Journal: Nat Commun Date: 2022-05-12 Impact factor: 17.694
Authors: Nelleke P M Brouwer; Amanda C R K Bos; Valery E P P Lemmens; Pieter J Tanis; Niek Hugen; Iris D Nagtegaal; Johannes H W de Wilt; Rob H A Verhoeven Journal: Int J Cancer Date: 2018-09-29 Impact factor: 7.396