Yibo Cai1, Guoping Cheng2, Xingang Lu3, Haixing Ju4, Xiu Zhu5. 1. Department of Colorectal Surgery, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China. 2. Department of Pathology, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China. 3. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China. 4. Department of Colorectal Surgery, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China. juhx@zjcc.org.cn. 5. Department of Pathology, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China. zhuxiu@zjcc.org.cn.
Abstract
PURPOSE: Adequate lymphadenectomy is critical for accurate nodal staging and planning adjuvant therapy in colon cancer. However, the optimal lymph node (LN) yield for stage II right-sided colon cancer (RSCC) is still unclear. This population-based study aimed to determine the optimal LN yield associated with survival and LN positivity in patients with stage II RSCC. METHODS: All patients with stage II-III RSCC were identified from the Surveillance, Epidemiology, and End Results database over a 10-year interval (2006-2015). The optimal threshold for LN yield was explored using an outcome-oriented approach based on survival and LN positivity. RESULTS: The median number of LNs examined for all 17,385 patients with stage II RSCC was 17 (IQR 12-23). Nineteen LNs were determined as the optimal cut-off point to maximize survival benefit from lymphadenectomy. Increased LN yield was associated with a gradual increase in the risk of node positivity, with no change after 19 nodes. Compared with patients with 19 or more LNs examined, the group with fewer LNs had a significantly poor cancer-specific survival (< 12 nodes: hazard ratio (HR) 2.26, P < 0.001; 12-18 nodes: HR 1.58, P < 0.001) and overall survival (< 12 nodes: HR 1.80, P < 0.001; 12-18 nodes: HR 1.31, P < 0.001). Similar survival results were found in the validation cohort. Patients with older age, small tumor size, and appendix and transverse colon cancer were more likely to receive inadequate LN harvest. CONCLUSION: A minimum of 19 LNs is needed to be examined for optimal survival and adequate node staging in lymph node-negative RSCC.
PURPOSE: Adequate lymphadenectomy is critical for accurate nodal staging and planning adjuvant therapy in colon cancer. However, the optimal lymph node (LN) yield for stage II right-sided colon cancer (RSCC) is still unclear. This population-based study aimed to determine the optimal LN yield associated with survival and LN positivity in patients with stage II RSCC. METHODS: All patients with stage II-III RSCC were identified from the Surveillance, Epidemiology, and End Results database over a 10-year interval (2006-2015). The optimal threshold for LN yield was explored using an outcome-oriented approach based on survival and LN positivity. RESULTS: The median number of LNs examined for all 17,385 patients with stage II RSCC was 17 (IQR 12-23). Nineteen LNs were determined as the optimal cut-off point to maximize survival benefit from lymphadenectomy. Increased LN yield was associated with a gradual increase in the risk of node positivity, with no change after 19 nodes. Compared with patients with 19 or more LNs examined, the group with fewer LNs had a significantly poor cancer-specific survival (< 12 nodes: hazard ratio (HR) 2.26, P < 0.001; 12-18 nodes: HR 1.58, P < 0.001) and overall survival (< 12 nodes: HR 1.80, P < 0.001; 12-18 nodes: HR 1.31, P < 0.001). Similar survival results were found in the validation cohort. Patients with older age, small tumor size, and appendix and transverse colon cancer were more likely to receive inadequate LN harvest. CONCLUSION: A minimum of 19 LNs is needed to be examined for optimal survival and adequate node staging in lymph node-negative RSCC.
Authors: C A Bertelsen; A U Neuenschwander; J E Jansen; A Kirkegaard-Klitbo; J R Tenma; M Wilhelmsen; L A Rasmussen; L V Jepsen; B Kristensen; I Gögenur Journal: Br J Surg Date: 2016-01-18 Impact factor: 6.939
Authors: F N van Erning; R M P H Crolla; H J T Rutten; L V Beerepoot; J H J M van Krieken; V E P P Lemmens Journal: Eur J Cancer Date: 2014-12 Impact factor: 9.162
Authors: Garrett M Nash; David Row; Alexander Weiss; Jinru Shia; Jose G Guillem; Philip B Paty; Mithat Gonen; Martin R Weiser; Larissa K Temple; Garrett Fitzmaurice; W Douglas Wong Journal: Ann Surg Date: 2011-02 Impact factor: 12.969