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Lymph Node Evaluation and Long-Term Survival in Stage II and Stage III Colon Cancer: A National Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The most important prognostic factor in colonic cancer is the presence or absence of regional lymph nodes metastases. The aim of this study was to evaluate the relationship between 5-year mortality in the New Zealand population, and the number of nodes examined in Stage II and III colon cancers.

Methods

New Zealand Cancer Registry data were retrieved for patients with colonic cancer from January 1995 to July 2003. Patients with incomplete entries, Stage I tumors, and distant metastases were excluded from analysis. Univariate and Cox regression models were used with 5-year mortality as the primary endpoint.

Results

The study identified 4309 patients. Younger age, female gender, Pacific Island descent, and right-sided tumors were associated with significantly higher lymph node retrieval. Cox regression analysis showed that the number of nodes examined was a significant predictor of 5-year mortality when age, sex, ethnicity, and site were controlled for. Five-year survival consistently improved between nodal strata until the 16-node mark, above which survival advantage was minimal. For Stage III cancers, a higher lymph node ratio was associated with a significant increase in mortality.

Conclusions

Increased rates of nodal examination are associated with a significantly lower 5-year mortality for Stage II and III colonic cancer, but this survival advantage appears to be minimal after the 16-node mark. The lymph node ratio has been validated as a powerful predictor of survival in Stage III cancer. Our results support the current practice of harvesting and examining as many nodes as possible during attempted curative resection.

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Author information

Authors and Affiliations

  1. Department of Surgery, South Auckland Clinical School, Middlemore Hospital, P.O. Box 93311, Otahuhu, Auckland, New Zealand

    Ryash Vather MBChB, Tarik Sammour MBChB, Arman Kahokehr MBChB, Andrew B. Connolly FRACS & Andrew G. Hill MD, FRACS

Authors
  1. Ryash Vather MBChB
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  2. Tarik Sammour MBChB
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  3. Arman Kahokehr MBChB
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  4. Andrew B. Connolly FRACS
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  5. Andrew G. Hill MD, FRACS
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Corresponding author

Correspondence to Andrew G. Hill MD, FRACS.

Appendix 1

Appendix 1

Results of the Cox regression analysis

 

Regression coefficient (95% CI)

p value

Age

1.026 (1.022–1.031)

<.0001

Gender

0.863 (0.794–0.938)

.001

Ethnicity

    Pacific Islander

 

<.0001

    Asian

0.527 (0.290–0.959)

.036

    European

0.716 (0.465–1.102)

.129

    Maori

0.896 (0.548–1.465)

.662

    Other/not otherwise specified

0.243 (0.122–0.485)

<.0001

Tumor site

    Transverse colon

 

.001

    Ascending colon

0.967 (0.839–1.115)

.648

    Descending colon

0.827 (0.715–0.957)

.011

    Not otherwise specified

1.183 (0.842–1.663)

.333

Number of nodes

    >25

 

<0.0001

    1–4

1.659 (1.376–2.000)

<0.0001

    5–8

1.443 (1.229–1.694)

<0.0001

    9–12

1.310 (1.118–1.535)

0.001

    13–16

1.063 (0.893–1.265)

0.491

    17–20

1.030 (0.845–1.256)

0.769

    21–24

1.103 (0.892–1.364)

0.366

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Vather, R., Sammour, T., Kahokehr, A. et al. Lymph Node Evaluation and Long-Term Survival in Stage II and Stage III Colon Cancer: A National Study. Ann Surg Oncol 16, 585–593 (2009). https://doi.org/10.1245/s10434-008-0265-8

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  • DOI: https://doi.org/10.1245/s10434-008-0265-8

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