Abstract
The elderly colon cancer (CC) patients are increasing and represent a heterogeneous patient group. The objectives of this study were to identify the features of lymph node examination and to explore the optimal minimum lymph node count after CC resection for patients aged ≥80. Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 65719 CC patients in stage I-III between 2004 and 2012, 26.0% of patients were aged ≥80. The median node count decreased with increasing age, which were 25.5, 20.2, 17.8 and 16.9 for patients aged 20–39, 40–59, 60–79, and ≥80. The rate of ≥12 nodes and the rate of node positivity for patients aged ≥80 were obviously lower than younger patients. Using X-tile analysis, we determined 9 nodes as the optimal node count for patients aged ≥80. Then, we compared the 5-year cancer specific survival (CSS) between patients with ≥9 nodes and <9 nodes. The results showed the 5-year CSSs were improved for patients with ≥9 nodes. Furthermore, the rate of node positivity and survival under the 9-node measure were equal to 12-node measure. Therefore, the lymph node examination should be discriminately evaluated for elder patients, and 9-node measure was available for patients aged ≥80.
Highlights
Patients currently account for a significant proportion of patients who are diagnosed with colon cancer (CC), which bring a challenge of dealing with an aging population to medical oncologists1. the US Preventive Services Task Force guidelines have showed that the percentage of colorectal cancer patients aged ≥75 increased from 29% to 40% between 1973 and 20072
We totally identified 65719 patients diagnosed with stage I-III CC from 2004 to 2012 in the SEER database, 17058 patients (26.0%) were aged 80 years and older
To confirm the value of 9-node measure for patient aged ≥80, we separately evaluate the effect of lymph node count on the rate of node positivity and long-term survival
Summary
Patients currently account for a significant proportion of patients who are diagnosed with colon cancer (CC), which bring a challenge of dealing with an aging population to medical oncologists1. the US Preventive Services Task Force guidelines have showed that the percentage of colorectal cancer patients aged ≥75 increased from 29% to 40% between 1973 and 20072. Accurate cancer staging is highly dependent on sufficient number of lymph nodes examination to detect the positive nodes[3]. Numerous studies have attempted to explore the optimal minimum lymph node count that contribute to improved tumor staging and survival outcomes, but individual studies varied widely in their recommendations for lymph node count to accurately detect the positive nodes[7,8,9]. The disparity in nodal examination gradually begs the question of whether the 12-node measure is an appropriate threshold for all CC patients. Elder CC patients have distinct characteristics that need to be taken into account regarding lymph node evaluation, especially for patients aged ≥8 013,14. Little attention has been paid to this issue, which contributed to a distinct lack of data on these elder patients. We evaluated the availability of this revised node measure by comparing the node positivity rate and long-term survival with the 12-node measure
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