Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Research article

Assessing the adequacy of lymph node yield for different tumor stages of colon cancer by nodal staging scores

Authors: Zhenyu Wu, Guoyou Qin, Naiqing Zhao, Huixun Jia, Xueying Zheng

Published in: BMC Cancer | Issue 1/2017

Login to get access

Abstract

Background

According to the current official guidelines, at least 12 lymph nodes (LNs) are qualified as an adequate sampling for colon cancer patients. However, patients evaluated with less nodes were still common in the United States, and the prevalence of positive nodal disease may be under-estimated because of the false-negative assessment. In this study, we present a statistical model that allows preoperative determination of the minimum number of lymph nodes needed to confirm a node-negative disease with certain confidence.

Methods

Adenocarcinoma colon cancer patients with stage T1-T3, diagnosed between 2004 and 2013, who did not receive neoadjuvant therapies and had at least one lymph node pathologically examined, were extracted from the Surveillance, Epidemiology and End Results (SEER) database. A beta binomial distribution was used to estimate the probability of an occult nodal disease is truly node-negative as a function of total number of LNs examined and T stage.

Results

A total of 125,306 patients met study criteria; and 47,788 of those were node-positive. The probability of falsely identifying a patient as node-negative decreased with an increasing number of nodes examined for each stage, and was estimated to be 72% for T1 and T2 patients with a single node examined and 57% for T3 patients with a single node examined. To confirm an occult nodal disease with 90% confidence, 3, 8, and 24 nodes need to be examined for patients from stage T1, T2, and T3, respectively.

Conclusions

The false-negative rate of diagnosed node negative, together with the minimum number of examined nodes for adequate staging, depend preoperatively on the clinical T stage. Predictive tools can recommend a threshold on the minimum number of examined nodes regarding to the favored level of confidence for each T stage.
Appendix
Available only for authorised users
Literature
1.
American Cancer Society. Cancer Facts & Figures 2016. Atlanta: American Cancer Society; 2016.
2.
American Cancer Society. Colorectal Cancer Facts & Figures 2014–2016. Atlanta: American Cancer Society; 2014.
3.
Akagi Y, Adachi Y, Kinugasa T, Oka Y, Mizobe T, Shirouzu K. Lymph node evaluation and survival in colorectal cancer: review of population-based, prospective studies. Anticancer Res. 2013;33(7):2839–47.PubMed
4.
Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99(6):433–41.CrossRefPubMed
5.
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.CrossRefPubMed
6.
7.
Hogan NM, Winter DC. A nodal positivity constant: new perspectives in lymph node evaluation and colorectal cancer. World J Surg. 2013;37(4):878–82.CrossRefPubMed
8.
Costi R, Beggi F, Reggiani V, Ricco M, Crafa P, Bersanelli M, Tartamella F, Violi V, Roncoroni L, Sarli L. Lymph node ratio improves TNM and Astler-Coller's assessment of colorectal cancer prognosis: an analysis of 761 node positive cases. J Gastroimtest Surg. 2014;18(10):1824–36.CrossRef
9.
Shanmugam C, Hines RB, Jhala NC, Katkoori VR, Zhang B, Posey JJ, Bumpers HL, Grizzle WE, Eltoum IE, Siegal GP, Manne U. Evaluation of lymph node numbers for adequate staging of Stage II and III colon cancer. J Hematol Oncol. 2011;4:25.CrossRefPubMedPubMedCentral
10.
Vather R, Sammour T, Kahokehr A, Connolly AB, Hill AG. Lymph node evaluation and long-term survival in stage II and stage III colon cancer: a national study. Ann Surg Oncol. 2009;16(3):585–93.CrossRefPubMed
11.
Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS. Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol. 1999;17(9):2896–900.CrossRefPubMed
12.
Gonen M, Schrag D, Weiser MR. Nodal staging score: a tool to assess adequate staging of node-negative colon cancer. J Clin Oncol. 2009;27(36):6166–71.CrossRefPubMedPubMedCentral
13.
Joseph NE, Sigurdson ER, Hanlon AL, Wang H, Mayer RJ, MacDonald JS, Catalano PJ, Haller DG. Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection. Ann Surg Oncol. 2003;10(3):213–8.CrossRefPubMed
14.
Iachetta F, Reggiani BL, Marcheselli L, Di Gregorio C, Cirilli C, Messinese S, Cervo GL, Postiglione R, Di Emidio K, Pedroni M, Longinotti E, Federico M, Ponz de Leon M. Lymph node evaluation in stage IIA colorectal cancer and its impact on patient prognosis: a population-based study. Acta Oncol. 2013;52(8):1682–90.CrossRefPubMed
15.
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.CrossRefPubMed
16.
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.CrossRefPubMed
17.
Chen HH, Chakravarty KD, Wang JY, Changchien CR, Tang R. Pathological examination of 12 regional lymph nodes and long-term survival in stages I-III colon cancer patients: an analysis of 2,056 consecutive patients in NE.Reftwo branches of same institution. Int J Color Dis. 2010;25(11):1333–41.CrossRef
18.
Tsai HL, Huang CW, Yeh YS, Ma CJ, Chen CW, Lu CY, Huang MY, Yang IP, Wang JY. Factors affecting number of lymph nodes harvested and the impact of examining a minimum of 12 lymph nodes in stage I-III colorectal cancer patients: a retrospective single institution cohort study of 1167 consecutive patients. BMC Surg. 2016;16:17.CrossRefPubMedPubMedCentral
19.
American Joint Committee on Cancer. Cancer staging manual. 5th ed. Chicago, IL: Springer; 1997.
20.
Bilimoria KY, Bentrem DJ, Stewart AK, Talamonti MS, Winchester DP, Russell TR, Ko CY. Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst. 2008;100(18):1310–7.CrossRefPubMedPubMedCentral
21.
Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93(8):583–96.CrossRefPubMed
22.
Robinson TJ, Thomas S, Dinan MA, Roman S, Sosa JA, Hyslop T. How many lymph nodes are enough? Assessing the adequacy of lymph node yield for papillary thyroid cancer. J Clin Oncol. 2016;34(28):3434–9.CrossRefPubMed
23.
Govindarajan A, Gonen M, Weiser MR, Shia J, Temple LK, Guillem JG, Paty PB, Nash GM. Challenging the feasibility and clinical significance of current guidelines on lymph node examination in rectal cancer in the era of neoadjuvant therapy. J Clin Oncol. 2011;29(34):4568–73.CrossRefPubMedPubMedCentral
24.
25.
Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(8 Suppl):IV-3-18.
26.
Jessup JM, McGinnis LS, Steele GJ, Menck HR, Winchester DP. The National Cancer Data Base. Report on colon cancer. Cancer. 1996;78(4):918–26.CrossRefPubMed
27.
Goldstein NS. Lymph node recovery from colorectal resection specimens. Dis Colon rectum. 1999;42(8):1107–8.CrossRefPubMed
28.
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.CrossRefPubMed
29.
Chen SL, Bilchik AJ. More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg. 2006;244(4):602–10.PubMedPubMedCentral
30.
Kluth LA, Abdollah F, Xylinas E, Rieken M, Fajkovic H, Seitz C, Sun M, Karakiewicz PI, Schramek P, Herman MP, et al. Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment. Br J Cancer. 2014;111(2):213–9.CrossRefPubMedPubMedCentral
31.
Shariat SF, Ehdaie B, Rink M, Cha EK, Svatek RS, Chromecki TF, Fajkovic H, Novara G, David SG, Daneshmand S, et al. Clinical nodal staging scores for bladder cancer: a proposal for preoperative risk assessment. Eur Urol. 2012;61(2):237–42.CrossRefPubMed
32.
Markl B, Olbrich G, Schenkirsch G, Kretsinger H, Kriening B, Anthuber M. Clinical significance of international union against cancer pN staging and lymph node ratio in node-positive colorectal cancer after advanced lymph node dissection. Dis Colon rectum. 2016;59(5):386–95.CrossRefPubMed
Metadata
Title
Assessing the adequacy of lymph node yield for different tumor stages of colon cancer by nodal staging scores
Authors
Zhenyu Wu
Guoyou Qin
Naiqing Zhao
Huixun Jia
Xueying Zheng
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3491-2

Other articles of this Issue 1/2017

BMC Cancer 1/2017 Go to the issue

Research article

Elevation of tumour markers TGF-β, M2-PK, OV-6 and AFP in hepatocellular carcinoma (HCC)-induced rats and their suppression by microalgae Chlorella vulgaris

Research article

The IGCA staging system is more accurate than AJCC7 system in stratifying survival of patients with gastric cancer in stage III

Research article

Succinate dehydrogenase deficiency in a PDGFRA mutated GIST

Research article

Oncological outcomes in an Australian cohort according to the new prostate cancer grading groupings

Research article

Global analysis of H3K27me3 as an epigenetic marker in prostate cancer progression

Study protocol

A French national breast and thyroid cancer screening programme for survivors of childhood, adolescent and young adult (CAYA) cancers - DeNaCaPST programme
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits