Journal Article

Prognostic value of total number of lymph nodes retrieved differs between left-sided colon cancer and right-sided colon cancer in stage III patients with colon cancer

Yang, Lin, He, Wenzhuo, Kong, Pengfei, Xie, Qiankun, Xiong, Zhenchong, Guo, Guifang, Xia, Liangping, Liu, Shousheng, Jiang, Chang

2018

Overview

Background The consensus is that a minimum of 12 lymph nodes should be analyzed at colectomy for colon cancer. However, right colon cancer and left colon cancer have different characteristics, and this threshold value for total number of lymph nodes retrieved may not be universally applicable. Methods The data of 63,243 patients with colon cancer treated between 2004 and 2012 were retrieved from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Multivariate Cox regression analysis was used to determine the predictive value of total number of lymph nodes for survival after adjusting for lymph nodes ratio. The predictive value in left-sided colon cancer and right-sided colon cancer was compared. The optimal total number of lymph nodes cutoff value for prediction of overall survival was identified using the online tool Cutoff Finder. Survival of patients with high total number of lymph nodes (≥12) and low total number of lymph nodes (< 12) was compared by Kaplan–Meier analysis. Results After stratifying by lymph nodes ratio status, total number of lymph nodes≥12 remained an independent predictor of survival in the whole cohort and in right-sided colon cancer, but not in left-sided colon cancer. The optimal cutoff value for total number of lymph nodes was determined to be 11. Low total number of lymph nodes (< 11) was associated with significantly poorer survival after adjusting for lymph nodes ratio in all subgroups except in the subgroup with high lymph nodes ratio (0.5–1.0). Conclusions Previous reports of the prognostic significance of total number of lymph nodes on node-positive colon cancer were confounded by lymph nodes ratio. The 12-node standard for total number of lymph nodes may not be equally applicable in right-sided colon cancer and left-sided colon cancer.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adenocarcinoma - mortality / Adenocarcinoma - pathology / Adenocarcinoma - surgery / Adjuvant chemotherapy / Adult / Aged / Aged, 80 and over / Biomedical and Life Sciences / Biomedicine / cancer imaging / Cancer Research / Care and treatment / Colectomy - methods / Colectomy - standards / Colon - pathology / Colon - surgery / Colon cancer / Colonic Neoplasms - mortality / Colonic Neoplasms - pathology / Colonic Neoplasms - surgery / Female / Follow-Up Studies / Health aspects / Health Promotion and Disease Prevention / Humans / interventional therapeutics / Kaplan-Meier Estimate / Left colon cancer / Lymph Node Excision - methods / Lymph Node Excision - standards / Lymph node ratio / Lymph nodes / Lymph Nodes - pathology / Lymphatic Metastasis / Male / Medicine/Public Health / Middle Aged / Neoplasm Staging / Oncology / Overall survival (OS) / Prognosis / Research Article / Right colon cancer / SEER Program - statistics & numerical data / Surgical Oncology / Total number of lymph nodes / Young Adult