Abstract
Background: Correct determination of nodal status is pivotal to accurate staging and predicting survival.
Methods: This is a secondary analysis of INT0089, an intergroup trial of adjuvant chemotherapy for high-risk stage II and III colon cancer. A subset of patients was studied who underwent right or left hemicolectomy and from whom at least 10 lymph nodes were examined. A mathematical model was created to estimate the probability of a true negative result on the basis of the number of nodes examined. The number of nodes needed to predict nodal negativity with 85%, 50%, and 25% probability on the basis of tumor stage was calculated.
Results: In this analysis, 1585 patients were studied. The average number of nodes removed at surgery was comparable between treatment groups at 18.5 (median of 16 in all groups). With this model, when 18 nodes are removed at resection, there is a <25% probability of true node negativity in T1/T2 tumors, whereas <10 nodes need to be examined in T3 and T4 tumors to achieve the same probability.
Conclusions: Tumor stage and the number of nodes retrieved at resection influence the accuracy of determining nodal status in colon cancer. Most patients are understaged. Underestimating nodal stage may influence decisions regarding adjuvant therapy, as well as overall prognosis.
REFERENCES
Hermanek P. pTNM and residual tumor classifications: problems of assessment and prognostic significance. World J Surg 1995; 19: 184–90.
Moertel CG. Chemotherapy for colorectal cancer. N Engl J Med 1994; 330: 1136–42.
O’Connell MJ. North Central Cancer Treatment Group—Mayo Clinic trials in colon cancer. Semin Oncol 2001; 28: 4–8.
O’Connell MJ, Maillard JA, Kahn MJ, et al. Controlled trial of fluorouracil and low dose leucovorin given for 6 months as postoperative adjuvant therapy for colon cancer. J Clin Oncol 1997; 15: 246–50.
Hernanz F, Revuelta S, Redondo C, et al. Colorectal adenocarcinoma: quality of the assessment of lymph node metastases. Dis Colon Rectum 1994; 37: 373–7.
Goldstein NS, Sanford W, Coffey M, Layfield LJ. Lymph node recovery from colorectal resection specimens removed for adenocarcinoma: trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 1996; 106: 209–16.
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: 2896–900.
Reinbach DH, McGregor JR, Murray GD, O’Dwyer PJ. Effect of the surgeon’s specialty interest on the type of resection performed for colorectal cancer. Dis Colon Rectum 1994; 37: 1020–3.
Scott KWM, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989; 76: 1165–7.
Kiricuta CI, Tausch J. A mathematical model of axillary lymph node involvement based on 1446 complete axillary dissections in patients with breast carcinoma. Cancer 1992; 69: 2496–501.
Herrera-Ornelas L. Metastases in small lymph nodes from colon cancer. Arch Surg 1987; 122: 1253–6.
Cohen AM, Kelsen D, Saltz L, et al. Adjuvant therapy for colorectal cancer. Curr Probl Cancer 1998; 22: 5–65.
Liefers G, Cleton-Jansen A, van de Velde CJ, et al. Micrometastases and survival in stage II colorectal cancer. N Engl J Med 1998; 339: 223–8.
Giacomantonia CA, Temple WJ. Quality of cancer surgery: challenges and controversies. Surg Oncol Clin North Am 2000; 9: 51–60.
Saettler EB, Temple WJ. The surgeon as a prognostic factor in the management of pancreatic cancer. Surg Oncol Clin North Am 2000; 9: 133–42.
Hartgrink HH, Bonenkamp HJ, van de Velde CJH. Influences of surgery on outcomes in gastric cancer. Surg Oncol Clin North Am 2000; 9: 97–117.
Hida J, Mori N, Kubo R, et al. Metastases from carcinoma of the colon and rectum detected in small lymph nodes by the clearing method. J Am Coll Surg 1994; 178: 223–8.
Rodriguez-Bigas MA, Maamoun S, Weber TK, et al. Clinical significance of colorectal cancer: metastases in lymph nodes <5 mm in size. Ann Surg Oncol 1996; 3: 124–30.
Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed. A secondary survey of INT-0089 (abstract). Proc Am Soc Clin Oncol 2000; 925.
Tepper JE, O’Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001; 19: 157–63.
Esser S, Reilly WT, Riley LB, et al. The role of sentinel lymph node mapping in staging of colon and rectal cancer. Dis Colon Rectum 2001; 44: 850–6.
Paramo JC, Summerall J, Wilson C, et al. Intraoperative sentinel lymph node mapping in patients with colon cancer. Am J Surg 2001; 182: 40–3.
Bendavid Y, Latulippe JF, Younan RJ, et al. Phase I study on sentinel lymph node mapping in colon cancer: a preliminary report. J Surg Oncol 2002; 79: 81–4.
Tsioulias GJ, Wood TF, Morton DL, et al. Lymphatic mapping and focused analysis of sentinel lymph nodes upstage gastrointestinal neoplasms. Arch Surg 2000; 135: 926–32.
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Joseph, N.E., Sigurdson, E.R., Hanlon, A.L. et al. Accuracy of Determining Nodal Negativity in Colorectal Cancer on the Basis of the Number of Nodes Retrieved on Resection. Ann Surg Oncol 10, 213–218 (2003). https://doi.org/10.1245/ASO.2003.03.059
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DOI: https://doi.org/10.1245/ASO.2003.03.059