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Observational Study
. 2017 Jul 14;15(1):129.
doi: 10.1186/s12916-017-0892-7.

The prognostic value of lymph node yield in the earliest stage of colorectal cancer: a multicenter cohort study

Yara Backes  1 , Sjoerd G Elias  2 , Bibie S Bhoelan  1 , John N Groen  3 , Jeroen van Bergeijk  4 , Tom C J Seerden  5 , Hendrikus J M Pullens  6 , Bernhard W M Spanier  7 , Joost M J Geesing  8 , Koen Kessels  9 , Marjon Kerkhof  10 , Peter D Siersema  1   11 , Wouter H de Vos Tot Nederveen Cappel  12 , Niels van Lelyveld  13 , Frank H J Wolfhagen  14 , Frank Ter Borg  15 , G Johan A Offerhaus  16 , Miangela M Lacle  16 , Leon M G Moons  17 ; Dutch T1 CRC Working Group
Affiliations
Observational Study

The prognostic value of lymph node yield in the earliest stage of colorectal cancer: a multicenter cohort study

Yara Backes et al. BMC Med. .

Abstract

Background: In patients with stage II colorectal cancer (CRC) the number of surgically retrieved lymph nodes (LNs) is associated with prognosis, resulting in a minimum of 10-12 retrieved LNs being recommended for this stage. Current guidelines do not provide a recommendation regarding LN yield in T1 CRC. Studies evaluating LN yield in T1 CRC suggest that such high LN yields are not feasible in this early stage, and a lower LN yield might be appropriate. We aimed to validate the cut-off of 10 retrieved LNs on risk for recurrent cancer and detection of LN metastasis (LNM) in T1 CRC, and explored whether this number is feasible in clinical practice.

Methods: Patients diagnosed with T1 CRC and treated with surgical resection between 2000 and 2014 in thirteen participating hospitals were selected from the Netherlands Cancer Registry. Medical records were reviewed to collect additional information. The association between LN yield and recurrence and LNM respectively were analyzed using 10 LNs as cut-off. Propensity score analysis using inverse probability weighting (IPW) was performed to adjust for clinical and histological confounding factors (i.e., age, sex, tumor location, size and morphology, presence of LNM, lymphovascular invasion, depth of submucosal invasion, and grade of differentiation).

Results: In total, 1017 patients with a median follow-up time of 49.0 months (IQR 19.6-81.5) were included. Four-hundred five patients (39.8%) had a LN yield ≥ 10. Forty-one patients (4.0%) developed recurrence. LN yield ≥ 10 was independently associated with a decreased risk for recurrence (IPW-adjusted HR 0.20; 95% CI 0.06-0.67; P = 0.009). LNM were detected in 84 patients (8.3%). LN yield ≥ 10 was independently associated with increased detection of LNM (IPW-adjusted OR 2.27; 95% CI 1.39-3.69; P = 0.001).

Conclusions: In this retrospective observational study, retrieving < 10 LNs was associated with an increased risk of CRC recurrence, advocating the importance to perform an appropriate oncologic resection of the draining LNs and diligent LN search when patients with T1 CRC at high-risk for LNM are referred for surgical resection. Given that both gastroenterologists, surgeons and pathologists will encounter T1 CRCs with increasing frequency due to the introduction of national screening programs, awareness on the consequences of an inadequate LN retrieval is of utmost importance.

Keywords: Lymph node metastasis; Lymph node retrieval; Malignant polyps; T1 colorectal carcinoma.

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Figures

Fig. 1
Fig. 1
Study flowchart. AJCC American Joint Committee on Cancer; CRC colorectal cancer; LN lymph node
Fig. 2
Fig. 2
Scatterplot of LN retrieval in T1 CRC over the years. Each dot represents one patient. The squares indicate the median LN yield per year
Fig. 3
Fig. 3
Kaplan–Meier curve of percentage of recurrence-free T1 CRC patients in relation to LN yield and presence of LNM. Green line: patients with T1 CRC without LNM and LN yield ≥ 10; orange line: patients with T1 CRC (with and without LNM) and LN yield ≥ 10; purple line: patients with T1 CRC without LNM and LN yield < 10; blue line: patients with T1 CRC (with and without LNM) and LN yield < 10; red line: patients with T1 CRC with LNM (irrespective of LN yield). The inset shows the same data on an enlarged y axis. Abbreviations: CRC: colorectal cancer; LN: lymph node; LNM: lymph node metastasis; nr: number
See this image and copyright information in PMC

References

    1. Amri R, Bordeianou LG, Sylla P, Berger DL. Impact of screening colonoscopy on outcomes in colon cancer surgery. JAMA Surg. 2013;148(8):747–54. doi: 10.1001/jamasurg.2013.8. - DOI - PubMed
    1. Yang DX, Gross CP, Soulos PR, Yu JB. Estimating the magnitude of colorectal cancers prevented during the era of screening: 1976 to 2009. Cancer. 2014;120(18):2893–901. doi: 10.1002/cncr.28794. - DOI - PubMed
    1. Ikematsu H, Yoda Y, Matsuda T, Yamaguchi Y, Hotta K, Kobayashi N, Fujii T, Oono Y, Sakamoto T, Nakajima T, et al. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology. 2013;144(3):551–9. doi: 10.1053/j.gastro.2012.12.003. - DOI - PubMed
    1. Bosch SL, Teerenstra S, de Wilt JH, Cunningham C, Nagtegaal ID. Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions. Endoscopy. 2013;45(10):827–34. doi: 10.1055/s-0033-1344238. - DOI - PubMed
    1. Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK. Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol. 2010;28(2):264–71. doi: 10.1200/JCO.2009.24.0952. - DOI - PMC - PubMed

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