Abstract
PurposeThe study aimed to analyze clinicopathological factors that determine the extent of lymph node retrieval and to evaluate its prognostic impact in patients with colorectal cancer (CRC).MethodsThe number of retrieved lymph nodes was analyzed in 381 CRC specimens. Lymph node count was related to different clinicopathological variables by binary logistic regression. Progression-free survival (PFS) and cancer-specific survival (CSS) were determined using the Kaplan-Meier method and Cox regression models.ResultsThe median number of retrieved lymph nodes was 20 (mean 21 ± 10, range 1–65) in right-sided, 13 (16 ± 10, 1–66) in left-sided, and 15 (18 ± 11, 3–64) in rectal tumors. The number of retrieved lymph nodes was independently associated with T-classification (p < 0.001), N-classification (p = 0.014), and tumor size (p = 0.005) as well as right-sided tumor location (p = 0.012). There was no association with age, sex, tumor grade, mismatch-repair status, and lymph or blood vessel invasion. The longer the surgical specimen, the higher were the numbers of retrieved and positive lymph nodes (p < 0.001, respectively). In patients with locally advanced (T3/T4) tumors (n = 283), analysis of more than 12 lymph nodes was independently associated with PFS (HR = 0.63, p = 0.025) and CSS (HR = 0.54, p = 0.004). In the subset of T3/T4 N0 patients (n = 130), analysis of more than 12 lymph nodes similarly proved to be an independent predictor of outcome (PFS, HR = 0.48, p = 0.046; OS, HR = 0.41, p = 0.026).ConclusionThe number of retrieved lymph nodes is associated with higher tumor stage, tumor size, and right-sided location. Low lymph node count indicates adverse outcome in patients with locally advanced (T3/T4) disease.
Highlights
Colorectal cancer (CRC) is globally the third most commonly diagnosed cancer in males and the second most common in females [1]
This difference was pronounced in patients with rectal cancer (N0 15.4 ± 9.3 retrieved lymph nodes versus N1/2 20.9 ± 12.3, p = 0.001) and almost significant in left-sided colon cancers (N0 14.1 ± 8.9 versus N1/2 17.5 ± 10.6, p = 0.075), while no difference was observed in right-sided cancers (N0 20.7 ± 9.1 versus N1/2 21.5 ± 12.1, p = 0.707, Fig. 1c–e)
The prognosis of patients with CRC after tumor resection depends substantially on the presence of lymph nodes involved by tumor cells
Summary
Colorectal cancer (CRC) is globally the third most commonly diagnosed cancer in males and the second most common in females [1]. It is a major contributor to cancer morbidity and mortality worldwide. In CRC, the involvement of lymph nodes by tumor cells represents a major step to systemic tumor spread and is a strong indicator of adverse prognosis [2]. Lymph node involvement is a determining variable of the AJCC/UICC TNM system, which is currently the most relevant prognostic classification and used as basis for therapeutic decisions [3, 4]. Patients without evidence of distant metastasis undergoing resection for primary colon cancer may receive adjuvant chemotherapy mainly based upon the identification of metastatic lymph nodes [5]. Adequate lymphadenectomy and sufficient lymph node retrieval from the resected specimen are crucial to ensure
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