Abstract
BackgroundLymph node status is the most important prognostic factor for colorectal cancer. The number of lymph nodes that should be histologically examined has been controversial. The aims of this study were to assess the impact of the number of lymph nodes examined on survival of patients with stage II colorectal cancer and to determine the optimal number of lymph nodes that should be examined.MethodsThe study included 664 patients who underwent resection for stage II colorectal cancer. The clinical and histopathologic data of the patients were prospectively collected and analyzed.ResultsThe median number of lymph nodes examined was 12 (range: 1 to 58). The 5-year disease free survival rate was significantly higher for patients with 12 or more lymph nodes examined compared to those with less than 12 lymph nodes examined. The significant difference in 5-year disease free survival persisted if the dividing number increased progressively from 12 to 23. However, the difference in survival was most significant (lowest p value and highest hazard ratio) for the number 21. The 5-year disease free survival of patients with 21 or more lymph nodes examined was 80% whereas that of patients with less than 21 lymph nodes examined was 60% (p = 0.001, hazard ratio 2.08). Multivariate analysis showed that 21 or more lymph nodes examined was a factor that independently influenced survival. The 5-year disease free survival also increased progressively with the number of lymph node examined up to the number 21. After the number 21, the survival rate did not increase further. It was likely that 21 was the optimal number, at and above which the chance of lymph node metastasis was minimal.ConclusionsThe number of lymph nodes examined in colorectal cancer specimen significantly influences survival. It is recommended that at least 21 lymph nodes should be examined for accurate diagnosis of stage II colorectal cancer.
Highlights
Lymph node status is the most important prognostic factor for colorectal cancer
It is recommended that at least 21 lymph nodes should be examined for accurate diagnosis of stage II colorectal cancer
The 5year disease free survival rate was significantly higher in patients underwent elective operation and in patients
Summary
Lymph node status is the most important prognostic factor for colorectal cancer. The aims of this study were to assess the impact of the number of lymph nodes examined on survival of patients with stage II colorectal cancer and to determine the optimal number of lymph nodes that should be examined. Accurate assessment for the presence of lymph node metastasis is critical in predicting the clinical outcome of patients who have undergone radical surgery for colorectal cancer. The status of the lymph nodes largely determines whether adjuvant chemotherapy should be given; such adjuvant chemotherapy has been shown unequivocally to provide disease-free as well as overall survival benefits in patients with node positive disease [1]. There is always a risk of disease understaging if the extent of lymph nodes assessment is sub-optimal.
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